| Doctor Name: | TARA MARIE BURK |
| NPI Number: | 1154605665 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMFT |
| License Number: | |
| Business Practice Address: | 10591 165th St W Lakeville, MN - 550443528 |
| Business Phone Number: | 9528981133 |
| Business Fax Number: | 9524356797 |
| Mailing Address: | 10591 165th St W, LAKEVILLE |
| State: | MN |
| Postal Code: | 550443528 |
| Phone Number: | 9528981133 |
| Fax Number: | 9524356797 |
| NPI Enumeration Date: | 10/03/2011 |
| NPI Last Update Date: | 09/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |