Healthcare Provider Details

I. General information

NPI: 1437912417
Provider Name (Legal Business Name): CARLY BURGER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD
DALLAS TX
75216-7167
US

IV. Provider business mailing address

1409 N ZANG BLVD APT 621
DALLAS TX
75203-1232
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-0534
  • Fax:
Mailing address:
  • Phone: 770-833-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP03296
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: