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General NPI Number Information
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NPI Number | 1629353057
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Entity Type | Individual
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Provider Name | MICHAEL DAVID BURKHOLDER MA, LMFT
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Gender | Male
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 1034 N 3RD ST SUITE 5-B
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3145
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Country | US
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Telephone | 208-667-9145
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Fax |
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Provider Business Mailing Address
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Address Line | 1034 N 3RD ST SUITE 5-B
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3145
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Country | US
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Telephone | 208-667-9145
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT 2680
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License Number State | ID
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