Provider Demographics
NPI:1821596867
Name:BURKS, JAMES EUGENE JR (LSAA, CPSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EUGENE
Last Name:BURKS
Suffix:JR
Gender:M
Credentials:LSAA, CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 1ST ST NW STE 200
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2311
Mailing Address - Country:US
Mailing Address - Phone:505-224-9124
Mailing Address - Fax:505-247-9503
Practice Address - Street 1:600 1ST ST NW STE 200
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2311
Practice Address - Country:US
Practice Address - Phone:505-224-9124
Practice Address - Fax:505-247-9503
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NMCTB-2022-0020101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator