MEDICARE: COURTNEY BURKHALTER

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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1396250494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY BURKHALTER

Provider Business Mailing Address
First Line	:	43950 HARBOR HILLS TER UNIT 307
Second Line	:
City	:	LANSDOWNE
State	:	VA
Zip	:	20176-3444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	44933 GEORGE WASHINGTON BLVD STE 115
Second Line	:
City	:	ASHBURN
State	:	VA
Zip	:	20147-6301
Country	:	US
Telephone Number	:	844-244-1818
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2017
Last Update Date	:	12/08/2020

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