Provider Demographics
NPI:1053305151
Name:BURKE, KARISA CORLEY (MED, MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:KARISA
Middle Name:CORLEY
Last Name:BURKE
Suffix:
Gender:F
Credentials:MED, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MANTOOTH AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3014
Mailing Address - Country:US
Mailing Address - Phone:936-639-4993
Mailing Address - Fax:936-639-6838
Practice Address - Street 1:1320 E HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-1761
Practice Address - Country:US
Practice Address - Phone:936-544-9484
Practice Address - Fax:936-544-9749
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19494101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health