Provider Demographics
NPI:1003951815
Name:BURKLE, GARY (MBA, MA, LPCC-S)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:BURKLE
Suffix:
Gender:M
Credentials:MBA, MA, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2690
Mailing Address - Country:US
Mailing Address - Phone:614-538-0353
Mailing Address - Fax:614-586-1879
Practice Address - Street 1:7195 COFFMAN RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1033
Practice Address - Country:US
Practice Address - Phone:614-538-0353
Practice Address - Fax:614-586-1879
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional