Healthcare Provider Details

I. General information

NPI: 1902550759
Provider Name (Legal Business Name): JULIANN BURKS LMFT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E MOUNTCASTLE DR STE 1
JOHNSON CITY TN
37601-2509
US

IV. Provider business mailing address

214 E MOUNTCASTLE DR STE 1
JOHNSON CITY TN
37601-2509
US

V. Phone/Fax

Practice location:
  • Phone: 423-283-4958
  • Fax: 423-283-7135
Mailing address:
  • Phone: 423-283-4958
  • Fax: 423-283-7135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JULIANN BURKS
Title or Position: LMFT/PRESIDENT
Credential: LMFT, MA
Phone: 828-898-4145