Healthcare Provider Details

I. General information

NPI: 1851925358
Provider Name (Legal Business Name): CASSANDRA LYNN BURNETTE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 10/24/2026
Certification Date: 10/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10777 S MEMORIAL DR STE E-1
TULSA OK
74133-7367
US

IV. Provider business mailing address

7711 E 111TH ST STE 111
TULSA OK
74133-2563
US

V. Phone/Fax

Practice location:
  • Phone: 918-727-2928
  • Fax: 918-727-2989
Mailing address:
  • Phone: 918-727-2928
  • Fax: 918-727-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-43165
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: