MEDICARE: JENNIFER REBEKAH BURKETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0704018535	VA

General Provider Information

NPI Number	:	1144191636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER REBEKAH BURKETT

Provider Business Mailing Address
First Line	:	215 N PAYNE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 N PAYNE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2444
Country	:	US
Telephone Number	:	717-256-1115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2025
Last Update Date	:	09/16/2025

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