Provider Demographics
NPI:1881564367
Name:BURRIS, MIKYLEE (LMSW, U/S)
Entity type:Individual
Prefix:
First Name:MIKYLEE
Middle Name:
Last Name:BURRIS
Suffix:
Gender:F
Credentials:LMSW, U/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74402-1267
Mailing Address - Country:US
Mailing Address - Phone:918-913-4463
Mailing Address - Fax:
Practice Address - Street 1:2310 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2761
Practice Address - Country:US
Practice Address - Phone:918-913-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-10
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK213361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical