Basic Information
| Provider Information | |||||||||
| NPI: | 1609906940 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNETT | ||||||||
| FirstName: | PRISCILLA | ||||||||
| MiddleName: | GEDDES | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 480914 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802480914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034550415 | ||||||||
| FaxNumber: | 3032964436 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 BROADWAY | ||||||||
| Address2: | STOUT STREET BRIDGES | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802052526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032964996 | ||||||||
| FaxNumber: | 3032964436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.