Healthcare Provider Details

I. General information

NPI: 1710402094
Provider Name (Legal Business Name): MONA BURNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W PROFESSIONAL PARK CT STE 1
BOWLING GREEN KY
42104-3250
US

IV. Provider business mailing address

181 W PROFESSIONAL PARK CT STE 1
BOWLING GREEN KY
42104-3250
US

V. Phone/Fax

Practice location:
  • Phone: 270-777-9283
  • Fax: 270-777-9283
Mailing address:
  • Phone: 270-777-9283
  • Fax: 270-777-9283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBCBA1-21-55572
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: