Provider Demographics
NPI:1356456750
Name:BURGESS, AUDREY FRANCES (PHD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:FRANCES
Last Name:BURGESS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AUDREY
Other - Middle Name:FRANCES
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:608 PEDEN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-1424
Mailing Address - Country:US
Mailing Address - Phone:713-377-8657
Mailing Address - Fax:
Practice Address - Street 1:608 PEDEN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-1424
Practice Address - Country:US
Practice Address - Phone:713-377-8657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32242103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87237AOtherBCBS PROVIDER I.D. NUMBER