Provider Demographics
NPI:1629118781
Name:BURTON, DEBRA LOUISE (NONE)
Entity Type:Individual
Prefix:MISS
First Name:DEBRA
Middle Name:LOUISE
Last Name:BURTON
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71302-4714
Mailing Address - Country:US
Mailing Address - Phone:318-448-6048
Mailing Address - Fax:
Practice Address - Street 1:242 WEST SHAMROCK STREET
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6439
Practice Address - Country:US
Practice Address - Phone:318-484-6334
Practice Address - Fax:318-484-6506
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2937101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2937OtherCOUNSELOR