Provider Demographics
NPI:1407528664
Name:BURTS, CONSTANCE R
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:R
Last Name:BURTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9841 SPARROW HAWK LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-4347
Mailing Address - Country:US
Mailing Address - Phone:832-419-8903
Mailing Address - Fax:
Practice Address - Street 1:9841 SPARROW HAWK LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-4347
Practice Address - Country:US
Practice Address - Phone:832-419-8903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78145101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional