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NPI Code Detail

MEDICARE: MR. JAMES H BURDICK MFT

MEDICARE: MR. JAMES H BURDICK MFT
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
1106H00000XMarriage & Family Therapist#0759NV
2101YM0800XMental Health Counselor0759NV

General Provider Information

NPI Number : 1508072539
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES H BURDICK MFT
Provider Business Mailing Address
First Line : 6075 STILLMEADOW DR
Second Line :
City : RENO
State : NV
Zip : 89502-8735
Country : US
Telephone Number : 775-856-1941
Fax Number :
Provider Business Practice Location Address
First Line : 205 SOUTH PRATT STREET
Second Line :
City : CARSON CITY
State : NV
Zip : 89701-4730
Country : US
Telephone Number : 775-882-3945
Fax Number : 775-882-6126
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 04/27/2011

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