Provider Demographics
NPI:1164641809
Name:BURKE, KATHRYN ALICE (LPCC-S)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ALICE
Last Name:BURKE
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 N HIGH ST LOWR 1
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3948
Mailing Address - Country:US
Mailing Address - Phone:614-885-0920
Mailing Address - Fax:
Practice Address - Street 1:5655 N HIGH ST LOWR 1
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3948
Practice Address - Country:US
Practice Address - Phone:614-885-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0008245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional