Provider Demographics
NPI:1558809889
Name:BURTON, JOHNNA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JOHNNA
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 S. JOPLIN AVE.
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-9165
Mailing Address - Country:US
Mailing Address - Phone:417-208-9825
Mailing Address - Fax:
Practice Address - Street 1:1618 S. JOPLIN AVE.
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-6480
Practice Address - Country:US
Practice Address - Phone:417-208-9825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1-21-54576103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst