Provider Demographics
NPI:1013367390
Name:BURK, MERCEDES (LPC LMFT)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:BURK
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 MARBLE FALLS DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-6696
Mailing Address - Country:US
Mailing Address - Phone:972-740-7632
Mailing Address - Fax:
Practice Address - Street 1:3145 MARBLE FALLS DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-6696
Practice Address - Country:US
Practice Address - Phone:972-740-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70303101YP2500X
TX202295106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist