Deanne Burke

Individual provider Active NPI Professional Counselor · Jenison, MI

NPI 1245092006 · NPPES record last updated Jan 26, 2024

Key facts

NPI
1245092006
Entity type
Individual (NPI type 1)
Primary specialty
Professional Counselor 101YP2500X
License
6451023072 (MI)
Practice address
1346 Baldwin St
Jenison, MI 49428-8937
Phone
(616) 765-8585
NPI assigned
Jan 26, 2024
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
6451023072MIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Tahoma Enterprises LLC Past
since Jan 28, 2024
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6451023072 MI Yes

Addresses

Primary practice location

1346 Baldwin St
Jenison, MI 49428-8937

Mailing address

269 Crestview Blvd
Commerce TWP, MI 48390-3937
Phone (248) 207-6922

Other names

  • Deanne Pratt Former name

Other providers in Jenison, MI

All providers in Jenison, MI · Professional Counselor in Michigan

Sources for this page

Verify at the official NPI Registry.