Provider Demographics
NPI:1508119496
Name:BURKS, KENYA MELINDA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KENYA
Middle Name:MELINDA
Last Name:BURKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 UNION AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-7559
Mailing Address - Country:US
Mailing Address - Phone:901-278-5400
Mailing Address - Fax:901-278-5200
Practice Address - Street 1:1331 UNION AVE STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7559
Practice Address - Country:US
Practice Address - Phone:901-278-5400
Practice Address - Fax:901-278-5200
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000005548104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker