Provider Demographics
NPI:1811537616
Name:BURCHETT, HEATHER (BCBA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BURCHETT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 FACULTY ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7316
Mailing Address - Country:US
Mailing Address - Phone:417-880-8372
Mailing Address - Fax:
Practice Address - Street 1:106 FACULTY ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7316
Practice Address - Country:US
Practice Address - Phone:417-880-8372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-412103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst