Provider Demographics
NPI:1851812663
Name:BURKS, RODERIC ALTON (MA, MS HSC, MS, LPC)
Entity Type:Individual
Prefix:
First Name:RODERIC
Middle Name:ALTON
Last Name:BURKS
Suffix:
Gender:M
Credentials:MA, MS HSC, MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9609 S UNIVERSITY BLVD UNIT 630015
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80163-3000
Mailing Address - Country:US
Mailing Address - Phone:720-334-1864
Mailing Address - Fax:
Practice Address - Street 1:1776 S JACKSON ST STE 211
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3823
Practice Address - Country:US
Practice Address - Phone:720-334-1864
Practice Address - Fax:720-230-5072
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013835101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional