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General NPI Number Information
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NPI Number | 1891348108
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Entity Type | Individual
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Provider Name | TIFFANY LYNN BURKHART LBA
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Gender | Female
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 10510 SPOTSYLVANIA AVE
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-2693
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Country | US
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Telephone | 540-479-3908
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Fax | 540-479-1608
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Provider Business Mailing Address
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Address Line | 10510 SPOTSYLVANIA AVE
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-2693
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Country | US
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Telephone | 540-479-3908
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Fax | 540-379-1605
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0133001430
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License Number State | VA
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