Provider Demographics
NPI:1316566938
Name:BURSTION, PORTIA (BS, QMHP)
Entity Type:Individual
Prefix:
First Name:PORTIA
Middle Name:
Last Name:BURSTION
Suffix:
Gender:F
Credentials:BS, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 W SAM HOUSTON PKWY S APT 6405
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2155
Mailing Address - Country:US
Mailing Address - Phone:713-539-7127
Mailing Address - Fax:
Practice Address - Street 1:2929 FM 2920 RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3428
Practice Address - Country:US
Practice Address - Phone:281-210-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor