Provider Demographics
NPI:1699283788
Name:BURKETT, DACIA LYNN
Entity type:Individual
Prefix:
First Name:DACIA
Middle Name:LYNN
Last Name:BURKETT
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 1:105 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:OK
Mailing Address - Zip Code:74016-2425
Mailing Address - Country:US
Mailing Address - Phone:918-500-6195
Mailing Address - Fax:
Practice Address - Street 1:105 S ELM ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:OK
Practice Address - Zip Code:74016-2425
Practice Address - Country:US
Practice Address - Phone:918-500-6195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)