Provider Demographics
NPI:1790010908
Name:BURKETT, LYNN KIMBERLIN (SPE)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:KIMBERLIN
Last Name:BURKETT
Suffix:
Gender:F
Credentials:SPE
Other - Prefix:MS
Other - First Name:LORA
Other - Middle Name:LYNN
Other - Last Name:BURKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPE
Mailing Address - Street 1:201 GILLESPIE DR
Mailing Address - Street 2:APARTMENT 14404
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7576
Mailing Address - Country:US
Mailing Address - Phone:615-243-5019
Mailing Address - Fax:615-732-2123
Practice Address - Street 1:201 GILLESPIE DR
Practice Address - Street 2:APARTMENT 14404
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-7576
Practice Address - Country:US
Practice Address - Phone:615-243-5019
Practice Address - Fax:615-732-2123
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11842101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor