Provider Demographics
NPI:1518354687
Name:BURKEEN, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BURKEEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 VIRGINIA ST
Mailing Address - Street 2:PO BOX 30
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5341
Mailing Address - Country:US
Mailing Address - Phone:731-642-0521
Mailing Address - Fax:731-642-1010
Practice Address - Street 1:408 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5341
Practice Address - Country:US
Practice Address - Phone:731-642-0521
Practice Address - Fax:731-642-1010
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000003322101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional