Provider Demographics
NPI:1275836579
Name:BURKET, BRIAN KENT (LPC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KENT
Last Name:BURKET
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6147 WOODBURY PIKE
Mailing Address - Street 2:
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673-8709
Mailing Address - Country:US
Mailing Address - Phone:814-224-4720
Mailing Address - Fax:814-224-4921
Practice Address - Street 1:6147 WOODBURY PIKE
Practice Address - Street 2:
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673-8709
Practice Address - Country:US
Practice Address - Phone:814-224-4720
Practice Address - Fax:814-224-4921
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional