Healthcare Provider Details

I. General information

NPI: 1295577500
Provider Name (Legal Business Name): DYLAN M BURKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date: 12/01/2025
Reactivation Date: 05/28/2026

III. Provider practice location address

10190 BANNOCK ST STE 120
NORTHGLENN CO
80260-6052
US

IV. Provider business mailing address

10190 BANNOCK ST STE 120
NORTHGLENN CO
80260-6052
US

V. Phone/Fax

Practice location:
  • Phone: 970-541-2056
  • Fax:
Mailing address:
  • Phone: 970-541-2056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: