Provider Demographics
NPI:1497828743
Name:BURKS, LINDA KAYE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:KAYE
Last Name:BURKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 S PINE ST
Mailing Address - Street 2:P.O. BOX 992
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4350
Mailing Address - Country:US
Mailing Address - Phone:405-533-3888
Mailing Address - Fax:405-533-2888
Practice Address - Street 1:807 S PINE ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4350
Practice Address - Country:US
Practice Address - Phone:405-533-3888
Practice Address - Fax:405-533-2888
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK643103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist