Provider Demographics
NPI:1891348108
Name:BURKHART, TIFFANY LYNN (LBA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LYNN
Last Name:BURKHART
Suffix:
Gender:F
Credentials:LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10510 SPOTSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-2693
Mailing Address - Country:US
Mailing Address - Phone:540-479-3908
Mailing Address - Fax:540-379-1605
Practice Address - Street 1:10510 SPOTSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2693
Practice Address - Country:US
Practice Address - Phone:540-479-3908
Practice Address - Fax:540-479-1608
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001430103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst