Provider Demographics
NPI:1932830478
Name:BURKE, KENNETH GREGORY (LPC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:GREGORY
Last Name:BURKE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 W 112TH TER
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1718
Mailing Address - Country:US
Mailing Address - Phone:816-289-2687
Mailing Address - Fax:913-273-1561
Practice Address - Street 1:9229 WARD PKWY STE 260
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3333
Practice Address - Country:US
Practice Address - Phone:816-289-2687
Practice Address - Fax:913-273-1561
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022020355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2022020355OtherSTATE OF MISSOURI