Provider Demographics
NPI:1912259219
Name:BURKETT, BRIAN JAMES
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
Last Name:BURKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 MEADOWIND CT
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-8939
Mailing Address - Country:US
Mailing Address - Phone:734-648-0061
Mailing Address - Fax:
Practice Address - Street 1:111 N 1ST ST
Practice Address - Street 2:#2
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1397
Practice Address - Country:US
Practice Address - Phone:734-648-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis