Basic Information
| Provider Information | |||||||||
| NPI: | 1548439615 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | BAMBI | ||||||||
| MiddleName: | AYLISHA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | BS PSYCHOLOGY MHPP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BURNS | ||||||||
| OtherFirstName: | BB | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2410 HIGHWAY 65 N | ||||||||
| Address2: | |||||||||
| City: | MC GEHEE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716549437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702223107 | ||||||||
| FaxNumber: | 8702226741 | ||||||||
| Practice Location | |||||||||
| Address1: | 790 ROBERTS DR | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716555723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703672461 | ||||||||
| FaxNumber: | 8704606133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2008 | ||||||||
| LastUpdateDate: | 02/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.