Provider Demographics
NPI:1245121912
Name:BURBANK, KEASA SATIA
Entity type:Individual
Prefix:
First Name:KEASA
Middle Name:SATIA
Last Name:BURBANK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20700 CIVIC CENTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4102
Mailing Address - Country:US
Mailing Address - Phone:800-385-1035
Mailing Address - Fax:
Practice Address - Street 1:20700 CIVIC CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4102
Practice Address - Country:US
Practice Address - Phone:800-385-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician