Provider Demographics
NPI:1407190382
Name:BURNARD, MAIA LYNN (MACP)
Entity Type:Individual
Prefix:
First Name:MAIA
Middle Name:LYNN
Last Name:BURNARD
Suffix:
Gender:F
Credentials:MACP
Other - Prefix:
Other - First Name:MAIA
Other - Middle Name:LYNN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACP
Mailing Address - Street 1:19747 SE 277TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-8562
Mailing Address - Country:US
Mailing Address - Phone:206-713-5327
Mailing Address - Fax:
Practice Address - Street 1:610 S YAKIMA AVE.
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402
Practice Address - Country:US
Practice Address - Phone:253-396-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health