Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6301009867 | MI |
NPI | 1043561731 |
---|---|
Provider Name | Ms. Debra Ann Burke |
First Address | Kentwood, MI 49508-5323 |
Second Address | Kentwood, MI 49508-5323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2012 |
Last Update Date | 21/09/2012 |