Provider Demographics
NPI:1588183180
Name:BURNS, BEVERLY (RBT)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:BURNS
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 1:1549 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4756
Mailing Address - Country:US
Mailing Address - Phone:509-735-1062
Mailing Address - Fax:
Practice Address - Street 1:1549 GEORGIA AVE. S.E.
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9935
Practice Address - Country:US
Practice Address - Phone:509-735-1062
Practice Address - Fax:509-737-8492
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARBT-17-39710106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician