Provider Demographics
NPI:1407327166
Name:BURNHAM, TAMMY ANN (CBT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:ANN
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SE BARRINGTON DR STE 203
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3200
Mailing Address - Country:US
Mailing Address - Phone:866-240-0808
Mailing Address - Fax:360-682-5551
Practice Address - Street 1:231 SE BARRINGTON DR STE 203
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3200
Practice Address - Country:US
Practice Address - Phone:866-240-0808
Practice Address - Fax:360-682-5551
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60884647101YA0400X
WA60969562106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)