Provider Demographics
NPI:1245695279
Name:BURTON SHEPHERD, LPC
Entity type:Organization
Organization Name:BURTON SHEPHERD, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:214-438-4835
Mailing Address - Street 1:5220 MCKINNEY AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3364
Mailing Address - Country:US
Mailing Address - Phone:214-438-4835
Mailing Address - Fax:
Practice Address - Street 1:5220 MCKINNEY AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3364
Practice Address - Country:US
Practice Address - Phone:214-438-4835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69977261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health