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General NPI Number Information
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NPI Number | 1689315079
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Entity Type | Individual
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Provider Name | JASON WAYNE BURKE LMFT NO.139625
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Gender | Male
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Dates
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Enumeration Date | 04/07/2022
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 380 S MELROSE DR STE 106
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City | VISTA
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State | CA
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Zip | 92081-6656
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Country | US
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Telephone | 760-688-2410
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Fax |
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Provider Business Mailing Address
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Address Line | 2725 JEFFERSON ST # 6-110
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City | CARLSBAD
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State | CA
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Zip | 92008-1705
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Country | US
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Telephone | 760-688-2410
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 125972
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License Number State | CA
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