Basic Information
| Provider Information | |||||||||
| NPI: | 1851752661 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKS | ||||||||
| FirstName: | MONIQUE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 W BARNETT SPRINGS AVE APT 236 | ||||||||
| Address2: | |||||||||
| City: | RUSTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712704880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106583541 | ||||||||
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| Practice Location | |||||||||
| Address1: | 103 4TH STREET | ||||||||
| Address2: | STEPPING STONES | ||||||||
| City: | JONESBORO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182591500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2016 | ||||||||
| LastUpdateDate: | 03/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.