Individual
JEFFREY W BURNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HSPP
Contact information
Practice address
611 LINCOLN WAY E, SOUTH BEND, IN 46601-3220
(574) 232-2255
(574) 232-8968
Mailing address
611 LINCOLN WAY E, SOUTH BEND, IN 46601-3220
(574) 232-2255
(574) 232-8968
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
20041003A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
148470X
UNSPECIFIED
IN
05
—
200200770A
—
IN
Enumeration date
03/02/2006
Last updated
12/10/2008
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