Doctor Name: | MR. GARY BURKLE |
NPI Number: | 1003951815 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MBA, MA, LPCC-S |
License Number: | E0003430 |
Business Practice Address: | 7195 Coffman Rd Dublin, OH - 430171033 |
Business Phone Number: | 6145380353 |
Business Fax Number: | 6145861879 |
Mailing Address: | 1115 Bethel Rd, COLUMBUS |
State: | OH |
Postal Code: | 432202690 |
Phone Number: | 6145380353 |
Fax Number: | 6145861879 |
NPI Enumeration Date: | 02/20/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | E0003430 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |