Provider Demographics
NPI:1538675137
Name:BURNETT, KARMELETA (LAC)
Entity Type:Individual
Prefix:
First Name:KARMELETA
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 E 13TH ST N STE E
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-1903
Mailing Address - Country:US
Mailing Address - Phone:316-214-0404
Mailing Address - Fax:866-950-2814
Practice Address - Street 1:2201 E 13TH ST N STE E
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-1903
Practice Address - Country:US
Practice Address - Phone:316-214-0404
Practice Address - Fax:866-950-2814
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)