Provider Demographics
NPI:1851665202
Name:BURNETT, COURTNEY R (M ED, BCBA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:R
Last Name:BURNETT
Suffix:
Gender:F
Credentials:M ED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8709 PALATINE AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3621
Mailing Address - Country:US
Mailing Address - Phone:206-962-0960
Mailing Address - Fax:
Practice Address - Street 1:5031 UNIVERSITY WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4341
Practice Address - Country:US
Practice Address - Phone:206-962-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-09-5661103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst