Provider Demographics
NPI:1366140196
Name:BURKS, ANNE A (MA, QMHP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:A
Last Name:BURKS
Suffix:
Gender:F
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20749 CANTERBURY CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2240
Mailing Address - Country:US
Mailing Address - Phone:541-788-0538
Mailing Address - Fax:
Practice Address - Street 1:20749 CANTERBURY CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2240
Practice Address - Country:US
Practice Address - Phone:541-788-0538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)