Provider Demographics
NPI:1033137807
Name:BURNETT, RICHARD L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:BURNETT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 TENAHA ST
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935
Mailing Address - Country:US
Mailing Address - Phone:936-598-6413
Mailing Address - Fax:936-598-4499
Practice Address - Street 1:325 TENAHA ST
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935
Practice Address - Country:US
Practice Address - Phone:936-598-6413
Practice Address - Fax:936-598-4499
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87269QOtherBCBS
TX87269QOtherBCBS