Healthcare Provider Details

I. General information

NPI: 1487573085
Provider Name (Legal Business Name): MICHAEL BURKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 FREMONT AVE STE 114
LOS ALTOS CA
94024-5602
US

IV. Provider business mailing address

851 FREMONT AVE STE 110
LOS ALTOS CA
94024-5602
US

V. Phone/Fax

Practice location:
  • Phone: 650-941-1698
  • Fax:
Mailing address:
  • Phone: 650-941-1698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT141976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: