Provider Demographics
NPI:1417429044
Name:STINE, BURTNETT (IADC)
Entity Type:Individual
Prefix:
First Name:BURTNETT
Middle Name:
Last Name:STINE
Suffix:
Gender:M
Credentials:IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-3426
Mailing Address - Country:US
Mailing Address - Phone:563-264-9406
Mailing Address - Fax:563-264-9501
Practice Address - Street 1:1605 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3426
Practice Address - Country:US
Practice Address - Phone:563-264-9406
Practice Address - Fax:563-264-9501
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)