Healthcare Provider Details

I. General information

NPI: 1508072109
Provider Name (Legal Business Name): A. JANINE BURKE M.A., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 12/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 ASPEN DR 302 A
SANTA FE NM
87505-5459
US

IV. Provider business mailing address

1105 DON GASPAR AVE
SANTA FE NM
87505-2660
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-8001
  • Fax: 505-983-3061
Mailing address:
  • Phone: 505-983-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0073981
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: