Healthcare Provider Details

I. General information

NPI: 1245356799
Provider Name (Legal Business Name): JOELLE S. BURKETT M.A., LSPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 MIDDLEBROOK PIKE
KNOXVILLE TN
37921
US

IV. Provider business mailing address

201 W SPRINGDALE AVE
KNOXVILLE TN
37917-5158
US

V. Phone/Fax

Practice location:
  • Phone: 865-444-2333
  • Fax:
Mailing address:
  • Phone: 865-637-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPE11708
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number11708
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: