Basic Information
| Provider Information | |||||||||
| NPI: | 1497921670 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNELL | ||||||||
| FirstName: | TYRONE | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 262 GOLF LINKS RD | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719017808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016257557 | ||||||||
| FaxNumber: | 5016207843 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 MAIN ST | ||||||||
| Address2: | SUITE V | ||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719134905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013218200 | ||||||||
| FaxNumber: | 5013218202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2008 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | AR | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.