Provider Demographics
NPI:1386136844
Name:BURKHARD, JEANA M
Entity type:Individual
Prefix:
First Name:JEANA
Middle Name:M
Last Name:BURKHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANA
Other - Middle Name:M
Other - Last Name:SCHEMANSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:51 AUSTIN STREET
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471
Mailing Address - Country:US
Mailing Address - Phone:810-689-4846
Mailing Address - Fax:810-958-1430
Practice Address - Street 1:805 S VAN DYKE RD STE C
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9655
Practice Address - Country:US
Practice Address - Phone:810-689-4846
Practice Address - Fax:810-958-1430
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017884101YM0800X, 101YM0800X
MI6401222337101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1386136844Medicaid