Provider Demographics
NPI:1891501391
Name:BURNETT, ALLEN FREAUX
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:FREAUX
Last Name:BURNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 E MOORE AVE OFC 5
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-5099
Mailing Address - Country:US
Mailing Address - Phone:501-236-0130
Mailing Address - Fax:
Practice Address - Street 1:1104 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72740-9672
Practice Address - Country:US
Practice Address - Phone:479-738-2878
Practice Address - Fax:479-738-1132
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR13121-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker