Provider Demographics
NPI:1649717430
Name:BURBA, JOSEPH MICHAEL (TCADC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:BURBA
Suffix:
Gender:M
Credentials:TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 S 4TH ST
Mailing Address - Street 2:APT #30
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-3256
Mailing Address - Country:US
Mailing Address - Phone:502-827-0843
Mailing Address - Fax:
Practice Address - Street 1:1026 S 4TH ST
Practice Address - Street 2:APT #30
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-3256
Practice Address - Country:US
Practice Address - Phone:502-827-0843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY168131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)