| Doctor Name: | MICHAEL KEITH BURNSIDE |
| NPI Number: | 1194739334 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC, LADC |
| License Number: | 553 |
| Business Practice Address: | 100 W 7th St Ste 102 Okmulgee, OK - 744475007 |
| Business Phone Number: | 9187581910 |
| Business Fax Number: | 9187561270 |
| Mailing Address: | 720 S 5th St, MORRIS |
| State: | OK |
| Postal Code: | 744452224 |
| Phone Number: | 9187334603 |
| Fax Number: | |
| NPI Enumeration Date: | 07/27/2006 |
| NPI Last Update Date: | 03/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 553 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |