Healthcare Provider Details

I. General information

NPI: 1386981934
Provider Name (Legal Business Name): TIFFANY NOELLE BURKE LCPC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 ARBOR GREEN TRL
O FALLON IL
62269-6787
US

IV. Provider business mailing address

12 WOLF CREEK DR STE 100
SWANSEA IL
62226-2314
US

V. Phone/Fax

Practice location:
  • Phone: 618-600-4502
  • Fax:
Mailing address:
  • Phone: 618-600-4502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: