Provider Demographics
NPI:1568646206
Name:BURKE, SUSAN WILLS (LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:WILLS
Last Name:BURKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6822 BENT OAK DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1434
Mailing Address - Country:US
Mailing Address - Phone:806-354-9721
Mailing Address - Fax:
Practice Address - Street 1:6666 W AMARILLO BLVD UNIT 4
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1752
Practice Address - Country:US
Practice Address - Phone:806-354-9721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09279101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional