Provider Demographics
NPI:1235636978
Name:BURROWS, DEANNA (RBT-18-53166)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:BURROWS
Suffix:
Gender:F
Credentials:RBT-18-53166
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11430 SAN JOSE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2392
Mailing Address - Country:US
Mailing Address - Phone:313-401-2418
Mailing Address - Fax:
Practice Address - Street 1:11430 SAN JOSE
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-2392
Practice Address - Country:US
Practice Address - Phone:313-401-2418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18-53166106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician