Provider Demographics
NPI:1336981968
Name:BURKMAN, DULCEY LARENE
Entity type:Individual
Prefix:
First Name:DULCEY
Middle Name:LARENE
Last Name:BURKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 TEAKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-4970
Mailing Address - Country:US
Mailing Address - Phone:208-440-3085
Mailing Address - Fax:
Practice Address - Street 1:171 TEAKWOOD ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-4970
Practice Address - Country:US
Practice Address - Phone:208-440-3085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician