Healthcare Provider Details

I. General information

NPI: 1467346007
Provider Name (Legal Business Name): BURNETT THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 COFFEE RD
MODESTO CA
95355-2308
US

IV. Provider business mailing address

2301 COFFEE RD
MODESTO CA
95355-2308
US

V. Phone/Fax

Practice location:
  • Phone: 707-299-8250
  • Fax: 707-635-8215
Mailing address:
  • Phone: 707-299-8250
  • Fax: 707-635-8215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MITZE BURNETT
Title or Position: OWNER
Credential:
Phone: 707-299-8250