Provider Demographics
NPI:1669605457
Name:BURDEN, MYRTLE LEE
Entity type:Individual
Prefix:MRS
First Name:MYRTLE
Middle Name:LEE
Last Name:BURDEN
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 1:149 W RAILROAD STREET
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:NC
Mailing Address - Zip Code:27812-1146
Mailing Address - Country:US
Mailing Address - Phone:252-325-5668
Mailing Address - Fax:
Practice Address - Street 1:149 W RAILROAD STREET
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:NC
Practice Address - Zip Code:27812-1146
Practice Address - Country:US
Practice Address - Phone:252-325-5668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator