Provider Demographics
NPI:1932136751
Name:WALDROP BURNETT, TERESA LYNN (LCSW, MT-BC)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LYNN
Last Name:WALDROP BURNETT
Suffix:
Gender:F
Credentials:LCSW, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8937 S GARNETT RD
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-6018
Mailing Address - Country:US
Mailing Address - Phone:918-872-9777
Mailing Address - Fax:
Practice Address - Street 1:8937 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-6018
Practice Address - Country:US
Practice Address - Phone:918-872-9777
Practice Address - Fax:918-872-9779
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK00810225A00000X
OK15421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist