Provider Demographics
NPI:1619374386
Name:BURNETT, KATAWNA
Entity Type:Individual
Prefix:MS
First Name:KATAWNA
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7548 W SAHARA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2779
Mailing Address - Country:US
Mailing Address - Phone:702-823-2313
Mailing Address - Fax:702-489-7760
Practice Address - Street 1:7548 W SAHARA AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2779
Practice Address - Country:US
Practice Address - Phone:702-823-2313
Practice Address - Fax:702-489-7760
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst