Provider Demographics
NPI:1154349215
Name:BURK, LAWRENCE PAUL SR (LPC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:PAUL
Last Name:BURK
Suffix:SR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:BURK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:4635 S LAKESHORE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7127
Mailing Address - Country:US
Mailing Address - Phone:480-345-4458
Mailing Address - Fax:480-345-4109
Practice Address - Street 1:4635 S LAKESHORE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7127
Practice Address - Country:US
Practice Address - Phone:480-345-4458
Practice Address - Fax:480-345-4109
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 0953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC 0953OtherSTATE LICENSE