MEDICARE: NENA BURNETTE LPC

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	101YP2500X	Professional Counselor	PO712069	AR
2	101YP2500X	Professional Counselor	P0712069	AR
3	101YP2500X	Professional Counselor	P2005011	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5A909	OTHER	AR	BCBS

General Provider Information

NPI Number	:	1710163027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NENA BURNETTE LPC

Provider Business Mailing Address
First Line	:	6009 CW POST RD
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401
Country	:	US
Telephone Number	:	870-932-0228
Fax Number	:	870-910-5689

Provider Business Practice Location Address
First Line	:	6009 CW POST RD
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401
Country	:	US
Telephone Number	:	870-932-0228
Fax Number	:	870-910-5689

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

Provider Enumeration Date	:	01/16/2008
Last Update Date	:	01/19/2022

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