Individual
KELLY BURDICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDC
Contact information
Practice address
4937 DILWORTH CT, FT WORTH, TX 76116-8836
(817) 730-1482
Mailing address
4937 DILWORTH CT, FT WORTH, TX 76116-8836
(817) 730-1482
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
9848
TX
Other
Enumeration date
01/05/2012
Last updated
01/05/2012
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