Provider Demographics
NPI:1639972003
Name:BURKS, MELISSA C
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:C
Last Name:BURKS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 DEANWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-6004
Mailing Address - Country:US
Mailing Address - Phone:443-759-2993
Mailing Address - Fax:
Practice Address - Street 1:500 MADISON AVE STE 200
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-1230
Practice Address - Country:US
Practice Address - Phone:443-759-2993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor