Provider Demographics
NPI:1619078557
Name:BURNS, LISA G (LCSW, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:G
Last Name:BURNS
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 CHURCHILL AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-1621
Mailing Address - Country:US
Mailing Address - Phone:225-978-3901
Mailing Address - Fax:225-923-1009
Practice Address - Street 1:763 NORTH BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-5725
Practice Address - Country:US
Practice Address - Phone:225-387-2287
Practice Address - Fax:225-383-2722
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA47561041C0700X
LA864106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist