Provider Demographics
NPI:1841234044
Name:BURKS, KATHEY STACK (LPC, LCDC,)
Entity Type:Individual
Prefix:MS
First Name:KATHEY
Middle Name:STACK
Last Name:BURKS
Suffix:
Gender:F
Credentials:LPC, LCDC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9550 FOREST LN.
Mailing Address - Street 2:BLDG. 1, SUITE 116
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5990
Mailing Address - Country:US
Mailing Address - Phone:972-250-1136
Mailing Address - Fax:972-661-1762
Practice Address - Street 1:9550 FOREST LN.
Practice Address - Street 2:BLDG. 1, SUITE 116
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5990
Practice Address - Country:US
Practice Address - Phone:972-250-1136
Practice Address - Fax:972-661-1762
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2013-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2825101YA0400X
TX8808101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2702LCOtherPROVIDER # FOR BC/BS