Provider Demographics
NPI:1114556818
Name:BURNS, LEANETTE MARIE (LCDC, LPC-INTERN)
Entity Type:Individual
Prefix:
First Name:LEANETTE
Middle Name:MARIE
Last Name:BURNS
Suffix:
Gender:F
Credentials:LCDC, LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LAURIE LN
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77378-8608
Mailing Address - Country:US
Mailing Address - Phone:402-415-8702
Mailing Address - Fax:
Practice Address - Street 1:101 LAURIE LN
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77378-8608
Practice Address - Country:US
Practice Address - Phone:402-415-8702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-04
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14646101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)