Healthcare Provider Details

I. General information

NPI: 1285872127
Provider Name (Legal Business Name): JILL A BURKE M.A., LPC, CFT, CACD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILL BALLMAN

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W GROVE ST LOWR LEVEL
CLARKS SUMMIT PA
18411-2023
US

IV. Provider business mailing address

219 W GROVE ST LOWR LEVEL
CLARKS SUMMIT PA
18411-2023
US

V. Phone/Fax

Practice location:
  • Phone: 570-909-9324
  • Fax:
Mailing address:
  • Phone: 570-909-9324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC005104
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF000580
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: