Provider Demographics
NPI:1366491979
Name:BURKE, CELIA A (PHD)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:A
Last Name:BURKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3037 NW 63RD ST
Mailing Address - Street 2:#105
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3637
Mailing Address - Country:US
Mailing Address - Phone:405-843-2303
Mailing Address - Fax:405-843-4322
Practice Address - Street 1:3037 NW 63RD ST
Practice Address - Street 2:#105
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3637
Practice Address - Country:US
Practice Address - Phone:405-843-2303
Practice Address - Fax:405-843-4322
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK852103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK73-1548177-001OtherBLUE CROSS BLUE SHIELD