Provider Demographics
NPI:1982769808
Name:BURKE, JOHN SHEPPARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SHEPPARD
Last Name:BURKE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 CARONDELET DR
Mailing Address - Street 2:SUITE 412
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4859
Mailing Address - Country:US
Mailing Address - Phone:816-763-6540
Mailing Address - Fax:816-943-6591
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:816-763-6540
Practice Address - Fax:816-943-6591
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3959689Medicare ID - Type Unspecified