Healthcare Provider Details

I. General information

NPI: 1821189358
Provider Name (Legal Business Name): MICHAEL BURKE, PSY.D. AND ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 AVENUE A SUITE E
KEARNEY NE
68847-8169
US

IV. Provider business mailing address

3720 AVENUE A SUITE E
KEARNEY NE
68847-8169
US

V. Phone/Fax

Practice location:
  • Phone: 308-234-5644
  • Fax: 308-234-5652
Mailing address:
  • Phone: 308-234-5644
  • Fax: 308-234-5652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SALLY J. WEGNER
Title or Position: OFFICE MANAGER
Credential:
Phone: 308-234-5644