Provider Demographics
NPI:1487394425
Name:BURNETT, SHONNA DANIELLE (MS, LPC, BC-TMH)
Entity type:Individual
Prefix:MS
First Name:SHONNA
Middle Name:DANIELLE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MS, LPC, BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 NICKS CV
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-5001
Mailing Address - Country:US
Mailing Address - Phone:870-559-9716
Mailing Address - Fax:
Practice Address - Street 1:909 NICKS CV
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-5001
Practice Address - Country:US
Practice Address - Phone:870-559-9716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2339101YP2500X
GA7327101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional