Provider Demographics
NPI:1023707890
Name:BURKS, RICHARD (PASTOR)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BURKS
Suffix:
Gender:M
Credentials:PASTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-8209
Mailing Address - Country:US
Mailing Address - Phone:662-347-0888
Mailing Address - Fax:
Practice Address - Street 1:2225 HIGHWAY 82 E
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-6841
Practice Address - Country:US
Practice Address - Phone:662-394-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor