Provider Demographics
NPI:1619366861
Name:BURKS, PATRICK
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:BURKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 HERITAGE PARK DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-0564
Mailing Address - Country:US
Mailing Address - Phone:615-691-5201
Mailing Address - Fax:615-396-8360
Practice Address - Street 1:132 HERITAGE PARK DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0564
Practice Address - Country:US
Practice Address - Phone:615-691-5201
Practice Address - Fax:615-396-8360
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health