Provider Demographics
NPI:1265634729
Name:BURSON, LINDA SHARON (DOCTORATE OF EDUCATI)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SHARON
Last Name:BURSON
Suffix:
Gender:F
Credentials:DOCTORATE OF EDUCATI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 INGLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8935
Mailing Address - Country:US
Mailing Address - Phone:979-690-6615
Mailing Address - Fax:
Practice Address - Street 1:1010 W JASPER DR STE 9
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-1328
Practice Address - Country:US
Practice Address - Phone:254-519-1144
Practice Address - Fax:254-519-1155
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1545101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional