Provider Demographics
NPI:1932136751
Name:BURNETT, TERESA LYNN (LCSW, MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LYNN
Last Name:BURNETT
Suffix:
Gender:F
Credentials:LCSW, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8115 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4331
Mailing Address - Country:US
Mailing Address - Phone:918-254-6315
Mailing Address - Fax:
Practice Address - Street 1:6216 S LEWIS AVE
Practice Address - Street 2:STE 180
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1077
Practice Address - Country:US
Practice Address - Phone:918-960-7047
Practice Address - Fax:539-664-5738
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK00810225A00000X
OK15421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist