Active NPI
Theresa M Burbank, MA LPC
- Mental Health Counselor
- Conroe, TX
National Provider Identifier
1083608988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 15294
- Practice address
- 112 West Pauline
Conroe, TX 77301 - Phone
- (936) 760-1880
- Fax
- (936) 760-9101
- NPI assigned
- Sep 7, 2005
- Last updated
- Mar 11, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 15294 | TX | Primary |
Addresses
Primary practice location
112 West Pauline
Conroe, TX 77301
Mailing address
112 West Pauline
Conroe, TX 77301
Phone (936) 760-1880
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1131716-02 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15294 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268265600000",
"number": "1083608988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 WEST PAULINE",
"city": "CONROE",
"state": "TX",
"postal_code": "77301",
"telephone_number": "936-760-1880",
"fax_number": "936-760-9101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 WEST PAULINE",
"city": "CONROE",
"state": "TX",
"postal_code": "77301",
"telephone_number": "936-760-1880",
"fax_number": "936-760-9101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURBANK",
"first_name": "THERESA",
"middle_name": "M",
"name_prefix": "Ms.",
"credential": "MA LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-09-07",
"last_updated": "2010-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "15294",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1131716-02",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conroe, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.