Provider Demographics
NPI:1275348179
Name:BURDINE, KIMBERLY (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:BURDINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14902 PRESTON RD. STE 404
Mailing Address - Street 2:UNIT 374
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 ELM AVE RM 201
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73019-3142
Practice Address - Country:US
Practice Address - Phone:405-325-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36914103TC1900X
OK1481103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling