Healthcare Provider Details

I. General information

NPI: 1033137807
Provider Name (Legal Business Name): RICHARD L BURNETT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 TENAHA ST
CENTER TX
75935
US

IV. Provider business mailing address

325 TENAHA ST
CENTER TX
75935
US

V. Phone/Fax

Practice location:
  • Phone: 936-598-6413
  • Fax: 936-598-4499
Mailing address:
  • Phone: 936-598-6413
  • Fax: 936-598-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12094
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: