Healthcare Provider Details

I. General information

NPI: 1952784936
Provider Name (Legal Business Name): JOYCELYN BURKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 W VINE ST
LIMA OH
45804-1054
US

IV. Provider business mailing address

809 W VINE ST
LIMA OH
45804-1054
US

V. Phone/Fax

Practice location:
  • Phone: 419-222-4474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number100049
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number100049
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: