Provider Demographics
NPI:1508015801
Name:BURKIG, THOMAS (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BURKIG
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:EDDY
Mailing Address - State:TX
Mailing Address - Zip Code:76524-2448
Mailing Address - Country:US
Mailing Address - Phone:254-859-5990
Mailing Address - Fax:254-859-5188
Practice Address - Street 1:480 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:EDDY
Practice Address - State:TX
Practice Address - Zip Code:76524-2448
Practice Address - Country:US
Practice Address - Phone:254-859-5990
Practice Address - Fax:254-859-5188
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16920101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172232401Medicaid