MEDICARE: BURKS COUNSELING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	LPC5032	ID

General Provider Information

NPI Number	:	1043643844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURKS COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	1674 W HILL RD
Second Line	:	SUITE 17
City	:	BOISE
State	:	ID
Zip	:	83702-0958
Country	:	US
Telephone Number	:	208-841-2641
Fax Number	:

Provider Business Practice Location Address
First Line	:	1674 W HILL RD
Second Line	:	SUITE 17
City	:	BOISE
State	:	ID
Zip	:	83702-0958
Country	:	US
Telephone Number	:	208-841-2641
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MRS. MICHELLE MARIE BURKS
Credential	:	LPC
Telephone Number	:	208-841-2641

Provider Enumeration Date	:	08/15/2013
Last Update Date	:	08/15/2013

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