Provider Demographics
NPI:1821078007
Name:BURNETT, DONNA L
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:L
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 1:5740 GATEWAY BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1893
Mailing Address - Country:US
Mailing Address - Phone:513-234-7870
Mailing Address - Fax:513-234-7836
Practice Address - Street 1:5740 GATEWAY BLVD
Practice Address - Street 2:STE 104
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1893
Practice Address - Country:US
Practice Address - Phone:513-234-7870
Practice Address - Fax:513-234-7836
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0005449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0175390Medicaid
OHH497100Medicare PIN
OH4471778OtherAETNA
OH000000038874OtherANTHEM
OH77199UBSOtherUNITED BEHAVIORAL HEALTH
OH2022141Medicare ID - Type UnspecifiedMEDICARE