Provider Demographics
NPI:1437655263
Name:BURNS, JAELYN (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JAELYN
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2933 CHEROKEE ST NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2884
Mailing Address - Country:US
Mailing Address - Phone:770-627-2267
Mailing Address - Fax:678-550-9396
Practice Address - Street 1:2933 CHEROKEE ST NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2884
Practice Address - Country:US
Practice Address - Phone:770-627-2267
Practice Address - Fax:678-550-9396
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-18-29859103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst