Provider Demographics
NPI:1285883637
Name:BURKE, SHARON MICHELLE (LPC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:MICHELLE
Last Name:BURKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 S JOHNSTONE AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-6636
Mailing Address - Country:US
Mailing Address - Phone:918-214-8685
Mailing Address - Fax:918-214-8949
Practice Address - Street 1:1110 SE FRANK PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-4318
Practice Address - Country:US
Practice Address - Phone:918-214-8685
Practice Address - Fax:918-214-8949
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK6051101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100732190CMedicaid