Healthcare Provider Details

I. General information

NPI: 1245837350
Provider Name (Legal Business Name): BRETT BURKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S MAIN ST
HOPE AR
71801-7243
US

IV. Provider business mailing address

141 W DODSON
CADDO VALLEY AR
71923-9605
US

V. Phone/Fax

Practice location:
  • Phone: 870-777-4848
  • Fax: 870-777-2410
Mailing address:
  • Phone: 501-428-2669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: