Provider Demographics
NPI:1407012719
Name:BURNS, MATTIE J
Entity Type:Individual
Prefix:MRS
First Name:MATTIE
Middle Name:J
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 1:106 BRUCE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-6204
Mailing Address - Country:US
Mailing Address - Phone:662-224-6763
Mailing Address - Fax:
Practice Address - Street 1:214 INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MS
Practice Address - Zip Code:38603-6761
Practice Address - Country:US
Practice Address - Phone:662-224-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health