Provider Demographics
NPI:1700468386
Name:BURKLY CLINICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:BURKLY CLINICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-846-6108
Mailing Address - Street 1:1764 MUSTANG CT
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-8483
Mailing Address - Country:US
Mailing Address - Phone:708-846-6108
Mailing Address - Fax:
Practice Address - Street 1:497 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5171
Practice Address - Country:US
Practice Address - Phone:708-846-6108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty