Healthcare Provider Details

I. General information

NPI: 1306554969
Provider Name (Legal Business Name): BONNIE ELIZABETH BURNSIDE LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BONNIE WARDEN

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 S LANCASTER RD
DALLAS TX
75216-4531
US

IV. Provider business mailing address

3429 SHEFFIELD CIR
PLANO TX
75075-3437
US

V. Phone/Fax

Practice location:
  • Phone: 214-371-0474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number10924
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: