Burnside, Michael Keith

Burnside, Michael Keith is an individual health care provider with primary practice located at 100 W 7Th St Ste 102 , Okmulgee OK 74447-5007. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is his primary health care specialty. Burnside, Michael Keith can be contacted via phone (918) 758-1910.

Contact Information

Primary practice address
100 W 7Th St Ste 102 Okmulgee OK 74447-5007
Phone: (918) 758-1910
Fax: (918) 756-1270
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 553 Oklahoma
Behavioral Health & Social Service Providers / Professional 101YP2500X 2650 Oklahoma

Profile Details

NPI number 1194739334
LBN Legal business name Burnside, Michael Keith
Credentials LPC, LADC
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2006
Last updated Mar 13th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194739334 NPPES
Oklahoma Other 300522336 MEDICARE

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