MEDICARE: BARBARA BURKS MCKENZIE BCBA

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	1062676	FL

General Provider Information

NPI Number	:	1740571470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA BURKS MCKENZIE BCBA

Provider Business Mailing Address
First Line	:	2161 COUNTY ROAD 540A #151
Second Line	:	2731 DEER RACK LANE
City	:	LAKELAND
State	:	FL
Zip	:	33813
Country	:	US
Telephone Number	:	863-604-9935
Fax Number	:

Provider Business Practice Location Address
First Line	:	2161 E COUNTY ROAD 540A # 151
Second Line	:	2731 DEER RACK
City	:	LAKELAND
State	:	FL
Zip	:	33813-3794
Country	:	US
Telephone Number	:	863-604-9935
Fax Number	:

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

Provider Enumeration Date	:	04/28/2011
Last Update Date	:	04/28/2011

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