Basic Information
| Provider Information | |||||||||
| NPI: | 1932136751 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNETT | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW, MT-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8115 S MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741334331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182546315 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6216 S LEWIS AVE | ||||||||
| Address2: | STE 180 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741361077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9189607047 | ||||||||
| FaxNumber: | 5396645738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 08/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225A00000X | 00810 | OK | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Music Therapist | 1041C0700X | 1542 | OK | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.