Provider Demographics
NPI:1548439615
Name:BURNS, BAMBI AYLISHA (BS PSYCHOLOGY MHPP)
Entity type:Individual
Prefix:
First Name:BAMBI
Middle Name:AYLISHA
Last Name:BURNS
Suffix:
Gender:F
Credentials:BS PSYCHOLOGY MHPP
Other - Prefix:
Other - First Name:BB
Other - Middle Name:
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2410 HIGHWAY 65 N
Mailing Address - Street 2:
Mailing Address - City:MC GEHEE
Mailing Address - State:AR
Mailing Address - Zip Code:71654-9437
Mailing Address - Country:US
Mailing Address - Phone:870-222-3107
Mailing Address - Fax:870-222-6741
Practice Address - Street 1:790 ROBERTS DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-5723
Practice Address - Country:US
Practice Address - Phone:870-367-2461
Practice Address - Fax:870-460-6133
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator