Provider Demographics
NPI:1134336522
Name:BURKETT, CYNTHIA M (LPC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:M
Last Name:BURKETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 ROOSEVELT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-5717
Mailing Address - Country:US
Mailing Address - Phone:817-461-3970
Mailing Address - Fax:817-457-4664
Practice Address - Street 1:2307 ROOSEVELT DR
Practice Address - Street 2:SUITE A
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-5717
Practice Address - Country:US
Practice Address - Phone:817-461-3970
Practice Address - Fax:817-457-4664
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12503101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional