Individual provider Active NPI

Debra Burklund, MA, LPC, LISAC

  • Professional Counselor
  • Gilbert, AZ
National Provider Identifier
1780674499
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC-11185 Issued in AZ
Practice address
207 N Gilbert Rd
Ste 107
Gilbert, AZ 85234-5812
Phone
(480) 345-1313
Fax
(480) 345-8282
NPI assigned
Oct 25, 2005
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC-11185 AZ Primary

Addresses

Primary practice location

207 N Gilbert Rd
Ste 107
Gilbert, AZ 85234-5812

Mailing address

653 W 10TH St
Mesa, AZ 85201-3204
Phone (480) 241-0234

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
LPC-11185AZMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Behavioral Health PC Past Accepting new patients
Wellspring Counselling Center, LLC Professional Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780674499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "653 W 10TH ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852013204",
            "telephone_number": "480-241-0234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 N GILBERT RD",
            "address_2": "STE 107",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852345812",
            "telephone_number": "480-345-1313",
            "fax_number": "480-345-8282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKLUND",
        "first_name": "DEBRA",
        "credential": "MA, LPC, LISAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "LPC-11185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.