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General NPI Number Information
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NPI Number | 1255501359
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Entity Type | Organization
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Legal Business Name | CAROL R BURKS PHD LLC
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 225 E IDAHO AVE SUITE 10
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City | LAS CRUCES
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State | NM
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Zip | 88005-3257
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Country | US
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Telephone | 575-524-8404
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16254
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City | LAS CRUCES
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State | NM
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Zip | 88004-6254
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHD/PRESIDENT
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Name | DR. CAROL R BURKS
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Credential | PHD
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Telephone | 575-524-8404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 651
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License Number State | NM
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