Provider Demographics
NPI:1659832483
Name:BURDETTE, STEVEN JEFFREY (LPCA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JEFFREY
Last Name:BURDETTE
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BERWICK DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2722
Mailing Address - Country:US
Mailing Address - Phone:859-358-0501
Mailing Address - Fax:
Practice Address - Street 1:100 BERWICK DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2722
Practice Address - Country:US
Practice Address - Phone:859-358-0501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY242651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health