Provider Demographics
NPI:1447905203
Name:BURKS, DANIEL WAYNE (LMFT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:WAYNE
Last Name:BURKS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E MOUNTCASTLE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2509
Mailing Address - Country:US
Mailing Address - Phone:423-283-4958
Mailing Address - Fax:
Practice Address - Street 1:214 E MOUNTCASTLE DR STE 1
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2509
Practice Address - Country:US
Practice Address - Phone:502-727-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-19
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1998106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist