Provider Demographics
NPI:1740881341
Name:BARBARA C BURT PSYD LLC
Entity type:Organization
Organization Name:BARBARA C BURT PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:619-729-7791
Mailing Address - Street 1:335 FOOTHILLS SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5027
Mailing Address - Country:US
Mailing Address - Phone:619-729-7791
Mailing Address - Fax:619-764-4020
Practice Address - Street 1:335 FOOTHILLS SOUTH DR
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5027
Practice Address - Country:US
Practice Address - Phone:619-729-7791
Practice Address - Fax:619-764-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty