JEFFREY W BURNETT HSPP NPI 1720055304

NPI Information

NPI: 1720055304
Provider Name: JEFFREY W BURNETT, HSPP
Classification: Psychologist - 103TB0200X
Entity Type: Individual

Specialization: Cognitive & Behavioral

Address:
611 LINCOLN WAY E
SOUTH BEND, IN
ZIP 46601
Phone: (574) 232-2255
Get Directions

Jeffrey W Burnett, HSPP is a cognitive and behavioral psychologist in South Bend, IN. The provider is a psychologist who reflects an experimental-clinical approach distinguished by use of principles of human learning and development and theories of cognitive processing to promote meaningful change in maladaptive human behavior and thinking. Jeffrey W Burnett, HSPP NPI is 1720055304. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

611 LINCOLN WAY E
SOUTH BEND, IN
ZIP 46601-220
Phone: (574) 232-2255
Fax: (574) 232-8968

The enumeration date for this NPI number is 3/2/2006 and was last updated on 12/10/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	103TB0200X	Psychologist	Cognitive & Behavioral	20041003A	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	148470X	OTHER	INDIANA	UNSPECIFIED
2	200200770A	MEDICAID	INDIANA
3	S19173	MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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