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General NPI Number Information
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NPI Number | 1639593627
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Entity Type | Organization
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Legal Business Name | BURKE GROUP COUNSELING & CONSULTING PROFESSIONALS LLC
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Dates
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Enumeration Date | 02/11/2014
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 4301 CANAL ST SUITE M
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City | GRANDVILLE
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State | MI
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Zip | 49418
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Country | US
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Telephone | 616-222-0631
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Fax | 616-222-0631
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Provider Business Mailing Address
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Address Line | 4301 CANAL ST SUITE M
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City | GRANDVILLE
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State | MI
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Zip | 49418
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Country | US
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Telephone | 616-222-0631
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Fax | 616-222-0631
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Authorized Official
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Title or Position | OWNER
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Name | DAVID BURKE
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Credential | LPC
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Telephone | 616-485-9167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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