Provider Demographics
NPI:1649691411
Name:BURKE, LYNDA (MASTERS CLINICIAN)
Entity type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:MASTERS CLINICIAN
Other - Prefix:MRS
Other - First Name:LYNDA
Other - Middle Name:
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASTER OF SCIENCE
Mailing Address - Street 1:320 FOX LN
Mailing Address - Street 2:
Mailing Address - City:MOORESBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37811-2532
Mailing Address - Country:US
Mailing Address - Phone:423-201-8852
Mailing Address - Fax:
Practice Address - Street 1:320 W 3RD NORTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4038
Practice Address - Country:US
Practice Address - Phone:423-581-4761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-21
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 103TF0000X, 103TC1900X
TN103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty