Provider Demographics
NPI:1780799924
Name:BURNHAM, BARBARA LEA (PHD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:LEA
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 WESTGATE BLVD
Mailing Address - Street 2:BLDG E, STE 501-F
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1495
Mailing Address - Country:US
Mailing Address - Phone:512-891-6400
Mailing Address - Fax:512-891-6400
Practice Address - Street 1:4701 WESTGATE BLVD
Practice Address - Street 2:BLDG E, STE 501-F
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1495
Practice Address - Country:US
Practice Address - Phone:512-891-6400
Practice Address - Fax:512-891-6400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25112103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist