Healthcare Provider Details

I. General information

NPI: 1336588185
Provider Name (Legal Business Name): JULIA STEWART BURNETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E WOODROW WILSON DRIVE
JACKSON MS
39216-5199
US

IV. Provider business mailing address

1500 E WOODROW WILSON DRIVE
JACKSON MS
39216-5199
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-4471
  • Fax: 601-368-4160
Mailing address:
  • Phone: 601-362-4471
  • Fax: 601-368-4160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15922
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: