Healthcare Provider Details

I. General information

NPI: 1821596867
Provider Name (Legal Business Name): JAMES EUGENE BURKS JR. LSAA, CPSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 GOLD AVE SW STE 1200
ALBUQUERQUE NM
87102-3276
US

IV. Provider business mailing address

600 1ST ST NW STE 200
ALBUQUERQUE NM
87102-2311
US

V. Phone/Fax

Practice location:
  • Phone: 505-224-9124
  • Fax: 505-247-9503
Mailing address:
  • Phone: 505-224-9124
  • Fax: 505-247-9503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCTB-2022-0020
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2022-0020
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: