Burnett, Jeffrey W

Burnett, Jeffrey W is an individual health care provider with primary practice located at 611 Lincoln Way E , South Bend IN 46601-3220. He recently has only one registered license in Behavioral Health & Social Service Providers / Cognitive & Behavioral, which is considered as his primary health care specialty. Burnett, Jeffrey W can be contacted via phone (574) 232-2255.

Contact Information

Primary practice address
611 Lincoln Way E South Bend IN 46601-3220
Phone: (574) 232-2255
Fax: (574) 232-8968
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Cognitive & Behavioral 103TB0200X 20041003A Indiana

Profile Details

NPI number 1720055304
LBN Legal business name Burnett, Jeffrey W
Credentials HSPP
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 2nd, 2006
Last updated Dec 10th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720055304 NPPES
Indiana Other 148470X UNSPECIFIED
Indiana MEDICAID 200200770A UNSPECIFIED

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