Healthcare Provider Details

I. General information

NPI: 1760317614
Provider Name (Legal Business Name): KARMIAH LATRICE BURKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7851 185TH ST STE 203
TINLEY PARK IL
60477-6503
US

IV. Provider business mailing address

PO BOX 12281
CHICAGO IL
60612-0281
US

V. Phone/Fax

Practice location:
  • Phone: 708-963-0334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.032713
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: