Provider Demographics
NPI:1104269356
Name:BURNETT, TANA MARGUERITE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:TANA
Middle Name:MARGUERITE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:TANA
Other - Middle Name:MARGUERITE
Other - Last Name:SUNDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:10615 PERRIN BEITEL RD
Mailing Address - Street 2:SUITE # 801
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3138
Mailing Address - Country:US
Mailing Address - Phone:210-657-7400
Mailing Address - Fax:888-506-2589
Practice Address - Street 1:10615 PERRIN BEITEL RD
Practice Address - Street 2:SUITE # 801
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3138
Practice Address - Country:US
Practice Address - Phone:210-657-7400
Practice Address - Fax:888-506-2589
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-13-12931103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst