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General NPI Number Information
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NPI Number | 1053408658
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Entity Type | Organization
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Legal Business Name | TOM C. BURDITT, JR.
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 2630 EXPOSITION BLVD STE 116
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City | AUSTIN
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State | TX
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Zip | 78703-1758
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Country | US
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Telephone | 512-322-0209
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Fax |
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Provider Business Mailing Address
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Address Line | 2630 EXPOSITION BLVD STE 116
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City | AUSTIN
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State | TX
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Zip | 78703-1758
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Country | US
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Telephone | 512-322-0209
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | TOM CONNOLLY BURDITT JR.
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Credential | LCSW
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Telephone | 512-322-0209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 000209
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License Number State | TX
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