MEDICARE: MRS. BRIDGET CAULLEY BURKHART LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	25519	TX

General Provider Information

NPI Number	:	1386603371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRIDGET CAULLEY BURKHART LCSW

Provider Business Mailing Address
First Line	:	5497 HOLLY SPRINGS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-2021
Country	:	US
Telephone Number	:	713-961-4340
Fax Number	:	713-961-4341

Provider Business Practice Location Address
First Line	:	5497 HOLLY SPRINGS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-2021
Country	:	US
Telephone Number	:	713-961-4340
Fax Number	:	713-961-4341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	07/08/2007

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