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NPI Code Detail

MEDICARE: DR. RANDAL K BURLESON PSY.D.

MEDICARE: DR. RANDAL K BURLESON PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist570AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
151502966BUROTHERALFED BCBS

General Provider Information

NPI Number : 1063455194
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDAL K BURLESON PSY.D.
Provider Business Mailing Address
First Line : 4040 MEMORIAL PKWY SW
Second Line :
City : HUNTSVILLE
State : AL
Zip : 35802-4364
Country : US
Telephone Number : 256-533-1970
Fax Number : 256-532-4112
Provider Business Practice Location Address
First Line : 4040 MEMORIAL PKWY SW
Second Line :
City : HUNTSVILLE
State : AL
Zip : 35802-4364
Country : US
Telephone Number : 256-533-1970
Fax Number : 256-532-4112
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 07/08/2007

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