Provider Demographics
NPI:1285905083
Name:CYVIL B. BURKS, SR., LPC
Entity type:Organization
Organization Name:CYVIL B. BURKS, SR., LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CYVIL
Authorized Official - Middle Name:B
Authorized Official - Last Name:BURKS
Authorized Official - Suffix:SR
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-808-5229
Mailing Address - Street 1:PO BOX 12883
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73157-2883
Mailing Address - Country:US
Mailing Address - Phone:405-858-0600
Mailing Address - Fax:405-858-0602
Practice Address - Street 1:2212 NW 50TH ST
Practice Address - Street 2:SUITE 172C
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8086
Practice Address - Country:US
Practice Address - Phone:405-808-5229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1327101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty