Provider Demographics
NPI:1790558351
Name:BURKETT, DAVID MARK (LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARK
Last Name:BURKETT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 N 95TH AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4313
Mailing Address - Country:US
Mailing Address - Phone:623-234-9811
Mailing Address - Fax:623-234-9815
Practice Address - Street 1:1840 N 95TH AVE STE 160
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4313
Practice Address - Country:US
Practice Address - Phone:623-234-9811
Practice Address - Fax:623-234-9815
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-22580101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional