Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 04706 | MD |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 34964 | TX |
N | 103TA0700X | Adult Development & Aging Psychologist | 04706 | MD |
N | 103TA0700X | Adult Development & Aging Psychologist | 34964 | TX |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 34964 | TX |
Y | 103G00000X | Clinical Psychologist | 04706 | MD |
Y | 103TC0700X | Clinical Psychologist | 04706 | MD |
N | 103G00000X | Clinical Psychologist | 34964 | TX |
N | 103TC0700X | Clinical Psychologist | 34964 | TX |
N | 103TC1900X | Counseling Psychologist | 34964 | TX |
N | 103TH0004X | Health Psychologist | 34964 | TX |
N | 103TH0100X | Health Service | 34964 | TX |
N | 103TP2701X | Group Psychotherapist | 34964 | TX |
NPI | 1609902311 |
---|---|
Provider Name | Dr. Christopher Kenneth Burke |
First Address | Saint Paul, MN 55108-5276 |
Second Address | Saint Paul, MN 55108-5276 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 15/04/2013 |