Provider Demographics
NPI:1790077717
Name:BURSEY, CYNTHIA LOUISE LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LOUISE LEE
Last Name:BURSEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:LOUISE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3755
Mailing Address - Country:US
Mailing Address - Phone:214-908-6627
Mailing Address - Fax:
Practice Address - Street 1:1101 DEVONSHIRE DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3755
Practice Address - Country:US
Practice Address - Phone:214-908-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX060191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical