Provider Demographics
NPI:1891013660
Name:BURK, TODD (BA - PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:BURK
Suffix:
Gender:M
Credentials:BA - PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 N CLASSEN BLVD STE 135
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4624
Mailing Address - Country:US
Mailing Address - Phone:405-848-0011
Mailing Address - Fax:405-848-2111
Practice Address - Street 1:4801 N CLASSEN BLVD STE 135
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4624
Practice Address - Country:US
Practice Address - Phone:405-848-0011
Practice Address - Fax:405-848-2111
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst