Provider Demographics
NPI:1255859203
Name:BURNS, COURTNEY LEIGH
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEIGH
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:COURTNEY
Other - Middle Name:LEIGH
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1303 MCCRAE TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-3253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1075 KINWEST PKWY STE 107
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3411
Practice Address - Country:US
Practice Address - Phone:972-910-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX71323OtherLICENSED PROFESSIONAL COUNSELOR