Healthcare Provider Details

I. General information

NPI: 1598998544
Provider Name (Legal Business Name): COURTNEY BURNETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MENAUL BLVD NE CENTER FOR DEVELOPMENT AND DISABILITY
ALBUQUERQUE NM
87107-1851
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-3000
  • Fax: 505-272-5280
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1152
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1152
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: