Provider Demographics
NPI:1336584838
Name:BURKHART, PAMELA STARR (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:STARR
Last Name:BURKHART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 LAKE SHORE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3824
Mailing Address - Country:US
Mailing Address - Phone:217-422-0027
Mailing Address - Fax:217-422-0041
Practice Address - Street 1:7360 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62522-9686
Practice Address - Country:US
Practice Address - Phone:217-855-7856
Practice Address - Fax:217-963-2655
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0154191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical