Jeffrey W Burnett, HSPP

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

20041003A Issued in IN

Practice address

611 Lincoln Way E
South Bend, IN 46601-3220

Phone

(574) 232-2255

Fax

(574) 232-8968

NPI assigned

Mar 2, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228867200000",
    "number": "1720055304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 LINCOLN WAY E",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466013220",
            "telephone_number": "574-232-2255",
            "fax_number": "574-232-8968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 LINCOLN WAY E",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466013220",
            "telephone_number": "574-232-2255",
            "fax_number": "574-232-8968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNETT",
        "first_name": "JEFFREY",
        "middle_name": "W",
        "credential": "HSPP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2008-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "IN",
            "license": "20041003A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNSPECIFIED",
            "identifier": "148470X",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200200770A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren M Burish, ATC
• Freya L Burket, A.C.S.W., L.C.S.W.
• Jackie Burleson
• Alexia Burling, RBT
• Audrey Burnett, COTA
• Alexandria Burton, LSW
• Anna Burton
• Loren J Burton, PHD HSPP
• Rebecca Busenbark, PT, DPT
• Jada Rashon Bush, PHARMD

• Cognitive & Behavioral Psychologist in South Bend, IN
• Providers in South Bend, IN by specialty
• Cognitive & Behavioral Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.