Provider Demographics
NPI:1083343644
Name:BURSON, AMY (BCBA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BURSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2301 E YEAGER DR STE 14
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1578
Mailing Address - Country:US
Mailing Address - Phone:602-606-2237
Mailing Address - Fax:844-475-2307
Practice Address - Street 1:21505 N 78TH AVE STE 125
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3356
Practice Address - Country:US
Practice Address - Phone:480-676-4714
Practice Address - Fax:844-475-2307
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZBEH-000869103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst