Provider Demographics
NPI:1679462774
Name:BURT, CRYSTAL (RBT)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:BURT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 REX LAKE RD, LEEDS, AL 35094
Mailing Address - Street 2:101
Mailing Address - City:LEEDS
Mailing Address - State:AL
Mailing Address - Zip Code:35094
Mailing Address - Country:US
Mailing Address - Phone:312-965-2997
Mailing Address - Fax:
Practice Address - Street 1:350 REX LAKE RD, LEEDS, AL 35094
Practice Address - Street 2:101
Practice Address - City:LEEDS
Practice Address - State:AL
Practice Address - Zip Code:35094
Practice Address - Country:US
Practice Address - Phone:312-965-2997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1305905106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician