Provider Demographics
NPI:1881889152
Name:BURKE COUNSELING & CONSULTING, INC.
Entity type:Organization
Organization Name:BURKE COUNSELING & CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:816-210-4982
Mailing Address - Street 1:7804 E 119TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-1310
Mailing Address - Country:US
Mailing Address - Phone:816-210-4982
Mailing Address - Fax:816-763-6540
Practice Address - Street 1:1010 CARONDELET DR
Practice Address - Street 2:SUITE 412
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4859
Practice Address - Country:US
Practice Address - Phone:816-210-4982
Practice Address - Fax:816-763-6540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22911041C0700X
MO20030037101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000D620Medicare PIN