Provider Demographics
NPI:1275867053
Name:LINA L. BURKHART, PH.D., PLLC
Entity Type:Organization
Organization Name:LINA L. BURKHART, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINA
Authorized Official - Middle Name:LYNISE
Authorized Official - Last Name:BURKHART
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:615-630-0315
Mailing Address - Street 1:5550 FRANKLIN PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220-2129
Mailing Address - Country:US
Mailing Address - Phone:615-630-0315
Mailing Address - Fax:615-373-3978
Practice Address - Street 1:5550 FRANKLIN PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-2129
Practice Address - Country:US
Practice Address - Phone:615-630-0315
Practice Address - Fax:615-373-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP2609103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514938Medicaid