Provider Demographics
NPI:1093817199
Name:BURKE, PATRICIA L (ACP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:BURKE
Suffix:
Gender:F
Credentials:ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 N FIELDER RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4635
Mailing Address - Country:US
Mailing Address - Phone:817-247-8706
Mailing Address - Fax:
Practice Address - Street 1:760 N FIELDER RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4635
Practice Address - Country:US
Practice Address - Phone:817-247-8706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19856106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117639803Medicaid
TX00S29ZMedicare PIN