MEDICARE: BRIAN KENT BURKET LPC

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	101YP2500X	Professional Counselor	PC003271	PA

General Provider Information

NPI Number	:	1275836579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN KENT BURKET LPC

Provider Business Mailing Address
First Line	:	6147 WOODBURY PIKE
Second Line	:
City	:	ROARING SPRING
State	:	PA
Zip	:	16673-8709
Country	:	US
Telephone Number	:	814-224-4720
Fax Number	:	814-224-4921

Provider Business Practice Location Address
First Line	:	6147 WOODBURY PIKE
Second Line	:
City	:	ROARING SPRING
State	:	PA
Zip	:	16673-8709
Country	:	US
Telephone Number	:	814-224-4720
Fax Number	:	814-224-4921

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

Provider Enumeration Date	:	12/08/2010
Last Update Date	:	12/08/2010

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