Provider Demographics
NPI:1700235488
Name:BURKE, JAY (LMFT)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:BURKE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 E KATELLA AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-5992
Mailing Address - Country:US
Mailing Address - Phone:213-293-6642
Mailing Address - Fax:
Practice Address - Street 1:2400 E KATELLA AVE STE 1200
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5992
Practice Address - Country:US
Practice Address - Phone:213-293-6642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91133106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist