Provider Demographics
NPI:1255997052
Name:BURKEY, HOLLY RUTH (NCC, LMHC-P)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:RUTH
Last Name:BURKEY
Suffix:
Gender:F
Credentials:NCC, LMHC-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8 - 7513 COURT STREET
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12932-0008
Mailing Address - Country:US
Mailing Address - Phone:518-873-3676
Mailing Address - Fax:518-873-3777
Practice Address - Street 1:7513 COURT STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NY
Practice Address - Zip Code:12932-0008
Practice Address - Country:US
Practice Address - Phone:518-873-3676
Practice Address - Fax:518-873-3777
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10227301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02996789Medicaid