Provider Demographics
NPI:1609421130
Name:BURLAK, NANCY GRACE (EDD, LMFT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:GRACE
Last Name:BURLAK
Suffix:
Gender:F
Credentials:EDD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 S 88TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9728
Mailing Address - Country:US
Mailing Address - Phone:303-673-9990
Mailing Address - Fax:
Practice Address - Street 1:2255 S 88TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9716
Practice Address - Country:US
Practice Address - Phone:303-673-9990
Practice Address - Fax:303-673-9703
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44507106H00000X
CO.0001519106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist