Provider Demographics
NPI:1942081096
Name:BURKE, KRYSTIL MIDORI (RMHCI)
Entity Type:Individual
Prefix:
First Name:KRYSTIL
Middle Name:MIDORI
Last Name:BURKE
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:KRYSTIL
Other - Middle Name:MIDORI
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3121 VILLAGE BLVD APT 108
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-7457
Mailing Address - Country:US
Mailing Address - Phone:803-673-6424
Mailing Address - Fax:
Practice Address - Street 1:4905 LANTANA RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6915
Practice Address - Country:US
Practice Address - Phone:561-340-7269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24445101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor