Provider Demographics
NPI:1184754277
Name:BURKE, MARTHA DIANNE (LMFT,LPC,LCDC)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:DIANNE
Last Name:BURKE
Suffix:
Gender:F
Credentials:LMFT,LPC,LCDC
Other - Prefix:MS
Other - First Name:MARTY
Other - Middle Name:D
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT,LPC,LCDC
Mailing Address - Street 1:6512 CIRCO DR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049
Mailing Address - Country:US
Mailing Address - Phone:682-936-9492
Mailing Address - Fax:
Practice Address - Street 1:6512 CIRCO DR
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049
Practice Address - Country:US
Practice Address - Phone:682-936-9492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3023101YA0400X
TX104138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)