Provider Demographics
NPI:1710611827
Name:BURKE, MOLLY
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6271 HILTON CT N
Mailing Address - Street 2:
Mailing Address - City:PINE SPRINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55115-6876
Mailing Address - Country:US
Mailing Address - Phone:651-955-3349
Mailing Address - Fax:
Practice Address - Street 1:6271 HILTON CT N
Practice Address - Street 2:
Practice Address - City:PINE SPRINGS
Practice Address - State:MN
Practice Address - Zip Code:55115-6876
Practice Address - Country:US
Practice Address - Phone:651-955-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health