Provider Demographics
NPI:1871603225
Name:BURNS, NANCY G (PSYD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:G
Last Name:BURNS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 IRON SPRINGS RD
Mailing Address - Street 2:STE 103
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-3313
Mailing Address - Country:US
Mailing Address - Phone:928-443-0661
Mailing Address - Fax:928-445-2919
Practice Address - Street 1:1680 IRON SPRINGS RD
Practice Address - Street 2:STE 103
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-3313
Practice Address - Country:US
Practice Address - Phone:928-443-0661
Practice Address - Fax:928-445-2919
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3167103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
46104OtherNATIONAL REGISTER
AZ0612660OtherBCBS
46104OtherNATIONAL REGISTER
AZ0612660OtherBCBS