Provider Demographics
NPI:1356622260
Name:BURKE, AMANDA LOWER (PHD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LOWER
Last Name:BURKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 PERSIMMON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7849
Mailing Address - Country:US
Mailing Address - Phone:405-613-8944
Mailing Address - Fax:
Practice Address - Street 1:1733 W 33RD ST STE 120
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3866
Practice Address - Country:US
Practice Address - Phone:405-285-7332
Practice Address - Fax:405-285-7338
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1354103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical