Basic Information
| Provider Information | |||||||||
| NPI: | 1053305151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | KARISA | ||||||||
| MiddleName: | CORLEY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.ED., M.A., LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 MANTOOTH AVE | ||||||||
| Address2: | |||||||||
| City: | LUFKIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759043014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9366394993 | ||||||||
| FaxNumber: | 9366396838 | ||||||||
| Practice Location | |||||||||
| Address1: | 1320 E HOUSTON AVE | ||||||||
| Address2: | |||||||||
| City: | CROCKETT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 758351761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365449484 | ||||||||
| FaxNumber: | 9365449749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 19494 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.