| Doctor Name: | SHANNON MARIE BURKE |
| NPI Number: | 1922319938 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC |
| License Number: | T-0130231 |
| Business Practice Address: | 1701 Us. Rt. 66 Suite D Moriarty, NM - 87035 |
| Business Phone Number: | 5058329135 |
| Business Fax Number: | 5058329404 |
| Mailing Address: | Po Box 1978, MORIARTY |
| State: | NM |
| Postal Code: | 870351978 |
| Phone Number: | 5058329135 |
| Fax Number: | |
| NPI Enumeration Date: | 06/24/2010 |
| NPI Last Update Date: | 06/24/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | T-0130231 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |