Provider Demographics
NPI:1780674499
Name:BURKLUND, DEBRA (MA, LPC, LISAC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:BURKLUND
Suffix:
Gender:F
Credentials:MA, LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3204
Mailing Address - Country:US
Mailing Address - Phone:480-241-0234
Mailing Address - Fax:
Practice Address - Street 1:207 N GILBERT RD
Practice Address - Street 2:STE 107
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5812
Practice Address - Country:US
Practice Address - Phone:480-345-1313
Practice Address - Fax:480-345-8282
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11185101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional