Provider Demographics
NPI:1912986076
Name:BURKETT, MICHELE D (LCSW,LSCSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:D
Last Name:BURKETT
Suffix:
Gender:F
Credentials:LCSW,LSCSW
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:D
Other - Last Name:CRAFT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSCSW,LCSW
Mailing Address - Street 1:11598 S. LONGVIEW ST.
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5678
Mailing Address - Country:US
Mailing Address - Phone:816-260-6607
Mailing Address - Fax:
Practice Address - Street 1:10100 W 87TH ST STE 207
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-4628
Practice Address - Country:US
Practice Address - Phone:816-260-6607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0059731041C0700X
KS17911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200428130AMedicaid
KS200428130DMedicaid
MO497573006Medicaid