Provider Demographics
NPI:1134460884
Name:BURKE REYES, LYNN LOUISE (LPC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:LOUISE
Last Name:BURKE REYES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:LOUISE
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2803 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9641
Mailing Address - Country:US
Mailing Address - Phone:706-650-7707
Mailing Address - Fax:
Practice Address - Street 1:2803 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-9641
Practice Address - Country:US
Practice Address - Phone:706-650-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006381101YA0400X, 101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral