Provider Demographics
NPI:1447788146
Name:BURKS, BRIGETTE
Entity Type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:
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 1:712 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-2421
Mailing Address - Country:US
Mailing Address - Phone:318-878-6696
Mailing Address - Fax:
Practice Address - Street 1:712 FIRST ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232
Practice Address - Country:US
Practice Address - Phone:318-878-6696
Practice Address - Fax:318-878-6698
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC8506101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor