Isadora Burnham, LMFT
Individual provider Active NPI Marriage & Family Therapist · Douglas, GA
NPI 1881210102 · NPPES record last updated Jun 23, 2020
Key facts
- NPI
- 1881210102
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- MFT001771 (GA)
- Practice address
- 1005 Shirley Ave
Douglas, GA 31533-2123 - Phone
- (912) 449-7111
- NPI assigned
- Jun 23, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFT001771 | GA | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFT001771 | GA | Yes |
Addresses
Primary practice location
1005 Shirley Ave
Douglas, GA 31533-2123
Mailing address
1007 Mary St
Waycross, GA 31503-3823
Phone (912) 449-7111
Other providers in Douglas, GA
- Amanda Brulte
- Mark Thomas Brulte
- Susan W Bryant
- Jayla Snipes Bullock
- Kristin Margie Burnam
- Ashli Nicole Bussey
- Wandle Keith Butler
- Mary Ann Camp
- Care Medical Center LLC
- Care Medical Center LLC
All providers in Douglas, GA · Marriage & Family Therapist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.