Provider Demographics
NPI:1720091226
Name:BURT, ALLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:
Last Name:BURT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 BROOKVALE LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4031
Mailing Address - Country:US
Mailing Address - Phone:865-766-0075
Mailing Address - Fax:
Practice Address - Street 1:6025 BROOKVALE LN
Practice Address - Street 2:SUITE 205
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4031
Practice Address - Country:US
Practice Address - Phone:865-766-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1567103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3684462Medicaid
TN3684462Medicaid