Doctor Name: | JOHNNIE CALISTA BURT |
NPI Number: | 1083859169 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. |
License Number: | RO849 |
Business Practice Address: | 354 N Pacific Hwy Woodburn, OR - 970715148 |
Business Phone Number: | 5039805322 |
Business Fax Number: | |
Mailing Address: | Po Box 32, WOODBURN |
State: | OR |
Postal Code: | 970710032 |
Phone Number: | 5039805322 |
Fax Number: | |
NPI Enumeration Date: | 12/03/2008 |
NPI Last Update Date: | 12/03/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | RO849 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |