Provider Demographics
NPI:1982348207
Name:BURRELL, TYKESHA PORSHA (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:TYKESHA
Middle Name:PORSHA
Last Name:BURRELL
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 CROSSCREEK TRL
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1503
Mailing Address - Country:US
Mailing Address - Phone:205-382-9017
Mailing Address - Fax:
Practice Address - Street 1:737 CROSSCREEK TRL
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1503
Practice Address - Country:US
Practice Address - Phone:205-382-9017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5790B104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker