Provider Demographics
NPI:1962885319
Name:BURKETT, CASEY JON (LCPC)
Entity type:Individual
Prefix:MR
First Name:CASEY
Middle Name:JON
Last Name:BURKETT
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 W DAYTONA DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1026
Mailing Address - Country:US
Mailing Address - Phone:208-901-4989
Mailing Address - Fax:
Practice Address - Street 1:6401 W DAYTONA DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1026
Practice Address - Country:US
Practice Address - Phone:208-901-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5881101YM0800X
IDLCPC-7232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health