Provider Demographics
NPI:1669034260
Name:BURKE, ELIZABETH SANDERS (MMFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SANDERS
Last Name:BURKE
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4146 OUTER DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-4245
Mailing Address - Country:US
Mailing Address - Phone:205-887-1842
Mailing Address - Fax:
Practice Address - Street 1:909 18TH AVE S STE A101
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2102
Practice Address - Country:US
Practice Address - Phone:205-887-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1374101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor