Provider Demographics
NPI:1790820074
Name:BURNETT, AMBER M (LP, BEH ANALSYT)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:M
Last Name:BURNETT
Suffix:
Gender:F
Credentials:LP, BEH ANALSYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MI
Mailing Address - Zip Code:49078-0347
Mailing Address - Country:US
Mailing Address - Phone:269-692-2100
Mailing Address - Fax:
Practice Address - Street 1:435 WHITCOMB ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-4291
Practice Address - Country:US
Practice Address - Phone:269-692-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009350101YM0800X
MI7401000870103K00000X
MI6301014241103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst