Provider Demographics
NPI:1598296964
Name:BURKS, JENNIFER LOUISE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOUISE
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 1:2410 E RIVERSIDE DR
Mailing Address - Street 2:SUITE G-3
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-3083
Mailing Address - Country:US
Mailing Address - Phone:512-804-3000
Mailing Address - Fax:512-323-9544
Practice Address - Street 1:2410 E RIVERSIDE DR
Practice Address - Street 2:SUITE G-3
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3083
Practice Address - Country:US
Practice Address - Phone:512-804-3000
Practice Address - Fax:512-323-9544
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional