Provider Demographics
NPI:1255603106
Name:BURKE, JOAN WILLIAMSON (LPC)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:WILLIAMSON
Last Name:BURKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:JOAN
Other - Middle Name:MAY
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11370 E JB LANE
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:134 B HWY OO
Practice Address - Street 2:
Practice Address - City:HALLSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65255
Practice Address - Country:US
Practice Address - Phone:573-356-9951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002321101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor