Provider Demographics
NPI:1306177969
Name:BURNS, JENNA MAEDEAN
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:MAEDEAN
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 TREEBARK DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-9743
Mailing Address - Country:US
Mailing Address - Phone:903-278-2477
Mailing Address - Fax:903-405-4672
Practice Address - Street 1:25 TREEBARK DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-9743
Practice Address - Country:US
Practice Address - Phone:903-278-2477
Practice Address - Fax:903-405-4672
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ARP1505054101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor