Provider Demographics
NPI:1013288034
Name:BURNETT, BROOKE EILEEN (MD, BCBA, LBA)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:EILEEN
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MD, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6521
Mailing Address - Country:US
Mailing Address - Phone:573-884-0664
Mailing Address - Fax:573-884-1151
Practice Address - Street 1:205 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6521
Practice Address - Country:US
Practice Address - Phone:573-884-0664
Practice Address - Fax:573-884-1151
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012001901103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst