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Jacquavious Deshawn Burt

NPI Registration Record

Provider / OrganizationNPIDate Certified
JACQUAVIOUS DESHAWN BURT12055644402022-08-14

Jacquavious Deshawn Burt is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1205564440. Registration indicates Jacquavious Deshawn Burt is a provider of services with a specialization in Behavioral Health & Social Service Providers, Behavior Technician (Behavior Technician, Behavioral Health & Social Service Providers) (Behavior Technician, )

Entity TypeIndividual
Provider Name Jacquavious Deshawn Burt
Practice Office Address6296 BRIDGEPORT VILLAGE SQUARE DR STE 2
BRIDGEPORT, MI US
Practice Office Telephone9894011239
Mailing Address5039 VILLA LINDE PKWY STE 30
FLINT, MI 485323450 US
Business Telephone9894012244
HPT Codes
CodePractice
License No
State
106S00000X PRIMARY
Behavioral Health & Social Service Providers
Behavior Technician
Behavior Technician
Behavioral Health & Social Service Providers
Behavior Technician
630356139055
MI
OPI Codes
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