Provider Demographics
NPI:1437469756
Name:BURKETT, ASHLEY CHRISTINE (LCMHC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CHRISTINE
Last Name:BURKETT
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-0330
Mailing Address - Country:US
Mailing Address - Phone:801-990-4300
Mailing Address - Fax:801-967-2127
Practice Address - Street 1:2711 S 8500 W
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044
Practice Address - Country:US
Practice Address - Phone:801-990-4300
Practice Address - Fax:801-967-2127
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011485101YP2500X
UT8739574-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional