Provider Demographics
NPI:1164940144
Name:WILLIAM A. BURKHART PHD LLC
Entity Type:Organization
Organization Name:WILLIAM A. BURKHART PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/ACCOUNT MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-365-1435
Mailing Address - Street 1:20056 19TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1211
Mailing Address - Country:US
Mailing Address - Phone:206-365-1435
Mailing Address - Fax:206-365-1428
Practice Address - Street 1:20056 19TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-1211
Practice Address - Country:US
Practice Address - Phone:206-365-1435
Practice Address - Fax:206-365-1428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001203103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty