Provider Demographics
NPI:1114524956
Name:BURKART, KIRSTEN THERESA (LCPC)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:THERESA
Last Name:BURKART
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 1:676 S FERGUSON AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-1952
Mailing Address - Country:US
Mailing Address - Phone:406-209-5777
Mailing Address - Fax:
Practice Address - Street 1:676 S FERGUSON AVE STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-1951
Practice Address - Country:US
Practice Address - Phone:406-209-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BBH-LCPC-LIC-37561101YP2500X
MTBBH-LCPC-LIC-37561101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-LCPC-LIC-37561OtherLCPC