Individual
MR. MIKE VINCENT BURCKHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
315 MAIN ST S, SUITE 315, MINOT, ND 58701-3956
(701) 852-5876
(701) 852-5883
Mailing address
315 MAIN ST S STE 315, MINOT, ND 58701-3956
(701) 852-5876
(701) 852-5883
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
120
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17415
BLUE CROSS ID NUMBER
ND
05
—
19118
—
ND
Enumeration date
10/08/2005
Last updated
11/18/2014
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