Individual
MRS. CAROLYN H BURNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
157 WALL ST, TENAHA, TX 75974-5413
(936) 248-4673
Mailing address
900 COUNTY ROAD 3849, JOAQUIN, TX 75954-3342
(936) 554-2388
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
39493
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
185639501
—
TX
05
—
185639502
—
TX
Enumeration date
01/09/2007
Last updated
10/28/2009
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