Provider Demographics
NPI:1215219100
Name:BURKE, ANGELIA T (BHRS)
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:T
Last Name:BURKE
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:T
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BHRS
Mailing Address - Street 1:14018 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1977
Mailing Address - Country:US
Mailing Address - Phone:405-302-2522
Mailing Address - Fax:405-302-2523
Practice Address - Street 1:14018 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1977
Practice Address - Country:US
Practice Address - Phone:405-302-2522
Practice Address - Fax:405-302-2523
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health