Provider Demographics
NPI:1831532357
Name:BURNETT, MATHEW VAUGHN (BS SOCIOLOGY)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:VAUGHN
Last Name:BURNETT
Suffix:
Gender:M
Credentials:BS SOCIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E D ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3322
Mailing Address - Country:US
Mailing Address - Phone:918-770-6918
Mailing Address - Fax:
Practice Address - Street 1:7010 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5713
Practice Address - Country:US
Practice Address - Phone:918-492-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor