Healthcare Provider Details

I. General information

NPI: 1033550520
Provider Name (Legal Business Name): JAYME ELIZABETH BURNETT-GREEN CBHCM II, CPRSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAYME ELIZABETH BURNETT-EVANS CBHCM II, CPRSS

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N TAYLOR AVE
WYNNEWOOD OK
73098-4626
US

IV. Provider business mailing address

207 N TAYLOR AVE
WYNNEWOOD OK
73098-4626
US

V. Phone/Fax

Practice location:
  • Phone: 405-207-0132
  • Fax: 405-251-5017
Mailing address:
  • Phone: 405-207-0132
  • Fax: 405-251-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: