MEDICARE: MS. BETTY JANE BURKE LPC

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	101YP2500X	Professional Counselor	0701001830	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053330555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BETTY JANE BURKE LPC

Provider Business Mailing Address
First Line	:	6620 SHINGLE RIDGE RD SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-6946
Country	:	US
Telephone Number	:	540-989-9537
Fax Number	:	540-989-3498

Provider Business Practice Location Address
First Line	:	3433 BRAMBLETON AVE
Second Line	:	SUITE 109 B
City	:	ROANOKE
State	:	VA
Zip	:	24018-6515
Country	:	US
Telephone Number	:	540-989-9537
Fax Number	:	540-989-3498

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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