Basic Information
| Provider Information | |||||||||
| NPI: | 1346536570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | IRENE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4180 S PECOS RD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891215074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024867593 | ||||||||
| FaxNumber: | 7024867576 | ||||||||
| Practice Location | |||||||||
| Address1: | 4180 S PECOS RD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891215074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024867593 | ||||||||
| FaxNumber: | 7024867576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2011 | ||||||||
| LastUpdateDate: | 06/27/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.