Provider Demographics
NPI:1134586357
Name:BURKETT, ANTHONY
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BURKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 LOCKE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5129
Mailing Address - Country:US
Mailing Address - Phone:817-886-3200
Mailing Address - Fax:
Practice Address - Street 1:5601 LOCKE AVE STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5129
Practice Address - Country:US
Practice Address - Phone:817-886-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2024-04-08
Deactivation Date:2020-08-18
Deactivation Code:
Reactivation Date:2024-01-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker