Shannon Marie Burke, LPCC
Individual provider Active NPI Mental Health Counselor · Moriarty, NM
NPI 1922319938 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1922319938
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 0156191 (NM)
- Practice address
- 1209 W US Route 66 Ste a
Moriarty, NM 87035-1039 - Phone
- (505) 220-6971
- Fax
- (505) 832-4441
- NPI assigned
- Jun 24, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1209 US Route 66 W
Moriarty, NM 87035-1039
Phone (505) 220-6971
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250103000972 | NM | Practitioner - Mental Health Counselor | 6507394590 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0156191 | NM | MD | Mental Health Counselor |
| T-0130231 | NM | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Positive Change Counseling, LLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | T-0130231 | NM | |
| Mental Health Counselor | 101YM0800X | 0156191 | NM | Yes |
Addresses
Primary practice location
1209 W US Route 66 Ste a
Moriarty, NM 87035-1039
Mailing address
21 Dingo Rd
Moriarty, NM 87035-5498
Phone (505) 220-6971
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841738820 | Other | BILLING NPI |
Other providers in Moriarty, NM
- Keirstin Bennett
- Kimberly A Birch
- Nicholas J. Black
- Chantala Booth
- Kathleen Brown
- City of Moriarty
- Jennifer Como
- Cornerstone Integrated Health LLC
- Susan Rae Early
- Tammy Ann Eastham
All providers in Moriarty, NM · Mental Health Counselor in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.