Basic Information
| Provider Information | |||||||||
| NPI: | 1609902311 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | KENNETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1360 ENERGY PARK DR | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551085276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516468985 | ||||||||
| FaxNumber: | 6516463959 | ||||||||
| Practice Location | |||||||||
| Address1: | 1360 ENERGY PARK DR | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551085276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516468985 | ||||||||
| FaxNumber: | 6516463959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 04/15/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 04706 | MD | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TA0400X | 04706 | MD | N | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TA0700X | 04706 | MD | N | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | 103TA0400X | 34964 | TX | N | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TA0700X | 34964 | TX | N | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | 103TC0700X | 34964 | TX | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TB0200X | 34964 | TX | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TP2701X | 34964 | TX | N | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | 103TC1900X | 34964 | TX | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TH0004X | 34964 | TX | N | Behavioral Health & Social Service Providers | Psychologist | Health | 103TH0100X | 34964 | TX | N | Behavioral Health & Social Service Providers | Psychologist | Health Service |
No ID Information.