Individual
MR. CASEY JON BURKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
6401 W DAYTONA DR, BOISE, ID 83709-1026
(208) 901-4989
Mailing address
6401 W DAYTONA DR, BOISE, ID 83709-1026
(208) 901-4989
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-7232
ID
101YM0800X
Mental Health Counselor
LPC-5881
ID
Other
Enumeration date
07/02/2015
Last updated
11/24/2021
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