Provider Demographics
NPI:1366049611
Name:BURKS, DEBORAH LYNN (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:BURKS
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-5024
Mailing Address - Country:US
Mailing Address - Phone:870-577-0905
Mailing Address - Fax:870-741-4520
Practice Address - Street 1:110 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-5024
Practice Address - Country:US
Practice Address - Phone:870-577-0905
Practice Address - Fax:870-741-4520
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10012-M1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool