Provider Demographics
NPI:1740523745
Name:BURKHART, ALYSON JANELL (BCBA)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:JANELL
Last Name:BURKHART
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:JANELL
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1312 PATTON RD
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3120
Mailing Address - Country:US
Mailing Address - Phone:620-792-4087
Mailing Address - Fax:620-792-4685
Practice Address - Street 1:1312 PATTON RD
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3120
Practice Address - Country:US
Practice Address - Phone:620-792-4087
Practice Address - Fax:620-792-4685
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS103K00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator