Provider Demographics
NPI:1073604385
Name:BURROW, KELLY L (LCMHT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:L
Last Name:BURROW
Suffix:
Gender:F
Credentials:LCMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1370
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866
Mailing Address - Country:US
Mailing Address - Phone:662-869-2138
Mailing Address - Fax:662-680-1601
Practice Address - Street 1:REGION III MENTAL HEALTH CENTER
Practice Address - Street 2:2434 SOUTH EASON BLVD
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-6942
Practice Address - Country:US
Practice Address - Phone:662-842-9217
Practice Address - Fax:662-680-1601
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health