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General NPI Number Information
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NPI Number | 1932622958
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Entity Type | Organization
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Legal Business Name | THOMAS K BURDENSKI PLLC
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Dates
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Enumeration Date | 07/21/2017
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Last Update Date | 07/21/2017
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Provider Practice Location Address
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Address Line | 6777 CAMP BOWIE BLVD STE 321
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City | FORT WORTH
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State | TX
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Zip | 76116-7178
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Country | US
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Telephone | 817-390-0453
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Fax |
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Provider Business Mailing Address
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Address Line | 1532 VERNON CASTLE AVE
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City | BENBROOK
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State | TX
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Zip | 76126-4291
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Country | US
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Telephone | 817-390-0453
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS KEVIN BURDENSKI
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Credential | PHD
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Telephone | 817-390-0453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 33118
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License Number State | TX
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