Provider Demographics
NPI:1790250835
Name:BURRISS, RONNIE LYNN
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:LYNN
Last Name:BURRISS
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 1:4910 26TH ST E APT 201
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-4945
Mailing Address - Country:US
Mailing Address - Phone:941-580-4858
Mailing Address - Fax:
Practice Address - Street 1:4910 26TH ST E APT 201
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4945
Practice Address - Country:US
Practice Address - Phone:941-580-4858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-63952106S00000X
FL0-23-14237106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician