Provider Demographics
NPI:1144007246
Name:BURKART, LAYNE
Entity type:Individual
Prefix:
First Name:LAYNE
Middle Name:
Last Name:BURKART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4380 OLD BAYOU TRL
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-3422
Mailing Address - Country:US
Mailing Address - Phone:850-963-7074
Mailing Address - Fax:
Practice Address - Street 1:231 BLUE STREAM WAY APT 5101
Practice Address - Street 2:
Practice Address - City:INLET BEACH
Practice Address - State:FL
Practice Address - Zip Code:32461-8621
Practice Address - Country:US
Practice Address - Phone:850-896-3873
Practice Address - Fax:855-508-6637
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-291385106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician