Provider Demographics
NPI:1386903235
Name:BURNAM, AMY D (MS, LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:BURNAM
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:D
Other - Last Name:SHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 ROSS RD
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:OK
Mailing Address - Zip Code:74730-4610
Mailing Address - Country:US
Mailing Address - Phone:405-593-7503
Mailing Address - Fax:
Practice Address - Street 1:4314 W HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-4588
Practice Address - Country:US
Practice Address - Phone:580-924-9441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225C00000X
OK6306101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor