Healthcare Provider Details

I. General information

NPI: 1265634729
Provider Name (Legal Business Name): LINDA SHARON BURSON DOCTORATE OF EDUCATI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W JASPER DR STE 9
KILLEEN TX
76542-1328
US

IV. Provider business mailing address

4911 INGLEWOOD CT
COLLEGE STATION TX
77845-8935
US

V. Phone/Fax

Practice location:
  • Phone: 254-519-1144
  • Fax: 254-519-1155
Mailing address:
  • Phone: 979-690-6615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1545
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: