Provider Demographics
NPI:1013461805
Name:BURKE, CHASITY (MS, LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:MS, LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 HIGHWAY 75
Mailing Address - Street 2:
Mailing Address - City:CALVIN
Mailing Address - State:OK
Mailing Address - Zip Code:74531-5051
Mailing Address - Country:US
Mailing Address - Phone:918-916-6961
Mailing Address - Fax:
Practice Address - Street 1:104 E CARL ALBERT PKWY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5092
Practice Address - Country:US
Practice Address - Phone:918-423-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health