Provider Demographics
NPI:1740571470
Name:MCKENZIE, BARBARA BURKS (BCBA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:BURKS
Last Name:MCKENZIE
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 1:2161 COUNTY ROAD 540A #151
Mailing Address - Street 2:2731 DEER RACK LANE
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813
Mailing Address - Country:US
Mailing Address - Phone:863-604-9935
Mailing Address - Fax:
Practice Address - Street 1:2161 E COUNTY ROAD 540A # 151
Practice Address - Street 2:2731 DEER RACK
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3794
Practice Address - Country:US
Practice Address - Phone:863-604-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1062676103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst