Burbank, Theresa M
Burbank, Theresa M is an sole proprietor health care provider with primary practice located at 112 West Pauline , Conroe TX 77301. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Burbank, Theresa M can be contacted via phone (936) 760-1880.Contact Information
Primary practice address
112 West Pauline
Conroe TX 77301
Phone: (936) 760-1880
Fax: (936) 760-9101
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 15294 | Texas |
Profile Details
| NPI number | 1083608988 |
|---|---|
| LBN Legal business name | Burbank, Theresa M |
| Credentials | MA LPC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 7th, 2005 |
| Last updated | Mar 11th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083608988 | NPPES |
| Texas | MEDICAID | 1131716-02 |
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