Provider Demographics
NPI:1073960795
Name:BURKMAN, MAKAYLA (LCPC)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:
Last Name:BURKMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 GLIMARY CT
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-5105
Mailing Address - Country:US
Mailing Address - Phone:208-317-2479
Mailing Address - Fax:
Practice Address - Street 1:2316 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-323-2273
Practice Address - Fax:208-323-1234
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-7003101YM0800X
IDLPC - 6171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health