Provider Demographics
NPI:1821189358
Name:MICHAEL BURKE, PSY.D. AND ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:MICHAEL BURKE, PSY.D. AND ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-234-5644
Mailing Address - Street 1:3720 AVENUE A
Mailing Address - Street 2:SUITE E
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8169
Mailing Address - Country:US
Mailing Address - Phone:308-234-5644
Mailing Address - Fax:308-234-5652
Practice Address - Street 1:3720 AVENUE A
Practice Address - Street 2:SUITE E
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8169
Practice Address - Country:US
Practice Address - Phone:308-234-5644
Practice Address - Fax:308-234-5652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-26Medicaid
NE=========-26Medicaid