Provider Demographics
NPI:1063841294
Name:BURD, ERIC JR
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BURD
Suffix:JR
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 1:9516 S SHIELDS BLVD
Mailing Address - Street 2:APT 8
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3100
Mailing Address - Country:US
Mailing Address - Phone:830-460-1200
Mailing Address - Fax:
Practice Address - Street 1:9516 S SHIELDS BLVD
Practice Address - Street 2:APT 8
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3100
Practice Address - Country:US
Practice Address - Phone:830-460-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000000000Medicaid