Provider Demographics
NPI:1194229633
Name:BURKE, MERRILEE (LMFT)
Entity Type:Individual
Prefix:
First Name:MERRILEE
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12011 ALBERS ST APT 6
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2161
Mailing Address - Country:US
Mailing Address - Phone:323-401-3916
Mailing Address - Fax:
Practice Address - Street 1:12843 LANDALE ST FL 3
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1352
Practice Address - Country:US
Practice Address - Phone:818-533-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105058101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty