Provider Demographics
NPI:1457782062
Name:BURKETT, VIRGINIA SHANNON (PHD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:SHANNON
Last Name:BURKETT
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 1:9525 KATY FWY
Mailing Address - Street 2:SUITE #228
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1407
Mailing Address - Country:US
Mailing Address - Phone:713-550-6200
Mailing Address - Fax:
Practice Address - Street 1:9525 KATY FWY
Practice Address - Street 2:SUITE #228
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1407
Practice Address - Country:US
Practice Address - Phone:713-550-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33419103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical