Provider Demographics
NPI:1417220161
Name:BURKETT, LORI MICHELLE (MA LPC-S NCC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MICHELLE
Last Name:BURKETT
Suffix:
Gender:F
Credentials:MA LPC-S NCC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:MICHELLE
Other - Last Name:ORTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 MED CT STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3483
Mailing Address - Country:US
Mailing Address - Phone:210-495-0675
Mailing Address - Fax:210-495-0884
Practice Address - Street 1:510 MED CT STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3483
Practice Address - Country:US
Practice Address - Phone:210-495-0675
Practice Address - Fax:210-495-0884
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63052101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional