MEDICARE: GENEVIEVE JANAE BURTON

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1699619874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENEVIEVE JANAE BURTON

Provider Business Mailing Address
First Line	:	6003 OLD BULLARD RD APT 117
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-4227
Country	:	US
Telephone Number	:	430-205-8710
Fax Number	:

Provider Business Practice Location Address
First Line	:	6003 OLD BULLARD RD APT 117
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-4227
Country	:	US
Telephone Number	:	430-205-8710
Fax Number	:

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

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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