Provider Demographics
NPI:1023565819
Name:BERNARD, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BERNARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SW THOMAS ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-3818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 SW THOMAS ST
Practice Address - Street 2:UNIT B
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3818
Practice Address - Country:US
Practice Address - Phone:817-862-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional