1508072109 NPI number — A. JANINE BURKE M.A., LPCC

Table of content: WILLIAM G COLEMAN MD (NPI 1124044086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508072109 NPI number — A. JANINE BURKE M.A., LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURKE
Provider First Name:
A.
Provider Middle Name:
JANINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508072109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1105 DON GASPAR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87505-2660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-983-8001
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1925 ASPEN DR
Provider Second Line Business Practice Location Address:
302 A
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-5459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-983-8001
Provider Business Practice Location Address Fax Number:
505-983-3061
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0073981 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 24928330 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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