Provider Demographics
NPI:1841229671
Name:BURHOLT, SYMEON PAUL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SYMEON
Middle Name:PAUL
Last Name:BURHOLT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 BARNETT ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4518
Mailing Address - Country:US
Mailing Address - Phone:830-257-3009
Mailing Address - Fax:830-257-3061
Practice Address - Street 1:616 BARNETT ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4518
Practice Address - Country:US
Practice Address - Phone:830-257-3009
Practice Address - Fax:830-257-3061
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX419721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX275447OtherCOMPSYCH
TX87620QOtherBC/BS OF TX
TN8G6362Medicare ID - Type Unspecified