Provider Demographics
NPI:1073762357
Name:BURNETT, TROY M (MSW)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:M
Last Name:BURNETT
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451-0428
Mailing Address - Country:US
Mailing Address - Phone:707-279-2061
Mailing Address - Fax:
Practice Address - Street 1:301 S STATE ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4906
Practice Address - Country:US
Practice Address - Phone:707-462-3041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker