MEDICARE: SALLY W BURMAN LCDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	8285	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8285	OTHER	TX	LICENSE NO.

General Provider Information

NPI Number	:	1316227705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY W BURMAN LCDC

Provider Business Mailing Address
First Line	:	2331 CORONADO PL
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77630-2261
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4305 TEJAS PKWY
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77632-1358
Country	:	US
Telephone Number	:	409-839-3852
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2011
Last Update Date	:	08/17/2011

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Directions to “ SALLY W BURMAN LCDC” Practice Location

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