Provider Demographics
NPI:1407041023
Name:BURKS, VICKI BUZBEE (PMHC)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:BUZBEE
Last Name:BURKS
Suffix:
Gender:F
Credentials:PMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8894 WAUKEENAH HWY
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-7075
Mailing Address - Country:US
Mailing Address - Phone:850-997-2445
Mailing Address - Fax:
Practice Address - Street 1:1616 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4619
Practice Address - Country:US
Practice Address - Phone:850-431-5910
Practice Address - Fax:850-431-6105
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMH834101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional