Provider Demographics
NPI:1710281480
Name:BUIRKLE, BRUCE WESLEY (LPC I)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:WESLEY
Last Name:BUIRKLE
Suffix:
Gender:M
Credentials:LPC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3767 FOREST LN
Mailing Address - Street 2:SUITE # 124, PMB # 1246
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-7100
Mailing Address - Country:US
Mailing Address - Phone:214-497-8389
Mailing Address - Fax:
Practice Address - Street 1:4347 W NORTHWEST HWY
Practice Address - Street 2:# 120-162
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-3864
Practice Address - Country:US
Practice Address - Phone:214-350-7289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67092101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist