Provider Demographics
NPI:1083330609
Name:BURKS, NIKISHA S
Entity Type:Individual
Prefix:
First Name:NIKISHA
Middle Name:S
Last Name:BURKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-0441
Mailing Address - Country:US
Mailing Address - Phone:313-492-5702
Mailing Address - Fax:
Practice Address - Street 1:1323 BUTTERFIELD RD STE 116
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5620
Practice Address - Country:US
Practice Address - Phone:708-364-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty