Provider Demographics
NPI:1558840876
Name:BURROWS, SHAMIA (RBT)
Entity Type:Individual
Prefix:
First Name:SHAMIA
Middle Name:
Last Name:BURROWS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 VALLEY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-4170
Mailing Address - Country:US
Mailing Address - Phone:314-662-2241
Mailing Address - Fax:
Practice Address - Street 1:510 W 10TH ST
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-2329
Practice Address - Country:US
Practice Address - Phone:850-815-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15-06230106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician