Healthcare Provider Details

I. General information

NPI: 1063395705
Provider Name (Legal Business Name): MISS ERIN ELIZABETH BURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 GOUGLER AVE
KENT OH
44240-2401
US

IV. Provider business mailing address

2748 HARTWOOD CIR
STOW OH
44224-5133
US

V. Phone/Fax

Practice location:
  • Phone: 330-673-1016
  • Fax:
Mailing address:
  • Phone: 330-697-1273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2506919-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: