Provider Demographics
NPI:1194389668
Name:BURGESS, STEVEN D (BCBA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:D
Last Name:BURGESS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-6823
Mailing Address - Country:US
Mailing Address - Phone:903-593-4004
Mailing Address - Fax:
Practice Address - Street 1:1722 W FRONT ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-6823
Practice Address - Country:US
Practice Address - Phone:903-593-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst