Provider Demographics
NPI:1275686719
Name:BURKE, CARLA EMILY (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:EMILY
Last Name:BURKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9214 CHEROKEE PL
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1704
Mailing Address - Country:US
Mailing Address - Phone:913-295-2764
Mailing Address - Fax:913-273-1561
Practice Address - Street 1:9229 WARD PKWY STE 290
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3346
Practice Address - Country:US
Practice Address - Phone:913-295-2764
Practice Address - Fax:913-273-1561
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999140256103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist