Provider Demographics
NPI:1497939318
Name:BURDENSKI, THOMAS KEVIN JR (LIC PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KEVIN
Last Name:BURDENSKI
Suffix:JR
Gender:M
Credentials:LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 VERNON CASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-4291
Mailing Address - Country:US
Mailing Address - Phone:817-390-0453
Mailing Address - Fax:817-732-7339
Practice Address - Street 1:6777 CAMP BOWIE BLVD
Practice Address - Street 2:SUITE 338
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-7155
Practice Address - Country:US
Practice Address - Phone:817-390-0453
Practice Address - Fax:817-732-7339
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20055101YP2500X
TX33118103TC1900X
TX4669106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist