Provider Demographics
NPI:1376914416
Name:BURANT, KATY M (MED, ED,S)
Entity Type:Individual
Prefix:MRS
First Name:KATY
Middle Name:M
Last Name:BURANT
Suffix:
Gender:F
Credentials:MED, ED,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2201
Mailing Address - Country:US
Mailing Address - Phone:440-439-4227
Mailing Address - Fax:
Practice Address - Street 1:475 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2201
Practice Address - Country:US
Practice Address - Phone:440-439-4227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1449395103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool