Individual
SHANNON MARIE BURKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
1209 W US ROUTE 66 STE A, MORIARTY, NM 87035-1039
(505) 220-6971
(505) 832-4441
Mailing address
21 DINGO RD, MORIARTY, NM 87035-5498
(505) 220-6971
(505) 832-4441
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0156191
NM
101YM0800X
Mental Health Counselor
T-0130231
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841738820
BILLING NPI
—
Enumeration date
06/24/2010
Last updated
07/21/2022
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