Provider Demographics
NPI:1760987796
Name:BURK, LAURA RENEE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RENEE
Last Name:BURK
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 1:7495 MCLAUGHLIN RD STE 200A
Mailing Address - Street 2:
Mailing Address - City:FALCON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4714
Mailing Address - Country:US
Mailing Address - Phone:197-430-5158
Mailing Address - Fax:
Practice Address - Street 1:7495 MCLAUGHLIN RD STE 200
Practice Address - Street 2:
Practice Address - City:FALCON
Practice Address - State:CO
Practice Address - Zip Code:80831-4714
Practice Address - Country:US
Practice Address - Phone:719-430-5158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0017063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional