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General NPI Number Information
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NPI Number | 1386136844
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Entity Type | Individual
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Provider Name | JEANA M BURKHARD
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Gender | Female
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 805 S VAN DYKE RD STE C
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City | BAD AXE
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State | MI
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Zip | 48413-9655
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Country | US
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Telephone | 810-689-4846
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Fax | 810-958-1430
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Provider Business Mailing Address
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Address Line | 51 AUSTIN STREET
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City | SANDUSKY
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State | MI
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Zip | 48471
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Country | US
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Telephone | 810-689-4846
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Fax | 810-958-1430
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401017884
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License Number State | MI
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