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1740086693 NPI number — FULISHA BURKS LCSW

NPI Number: 1740086693
Health Care Provider/Practitioner: FULISHA BURKS LCSW

Information about “1740086693” NPI (FULISHA BURKS LCSW) exists in 1740086693 in HTML format HTML  |  1740086693 in plain Text format TXT  |  1740086693 in PDF (Portable Document Format) PDF  |  1740086693 in an XML format XML  formats.

NPI Number : 1740086693 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740086693",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BURKS",
    "FirstName": "FULISHA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BURKS",
    "OtherFirstName": "FULISHA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "30 W PINEHURST CIR APT 302",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GLENDALE HEIGHTS",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60139-3633",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "111 W JACKSON BLVD STE 1700",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60604-3597",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "708-529-8252",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/21/2025",
    "LastUpdateDate": "04/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "149027973",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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