Provider Demographics
NPI:1689283343
Name:BURTON, LISA (ALPS, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:ALPS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 SW AVONDALE ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5053
Mailing Address - Country:US
Mailing Address - Phone:304-389-2559
Mailing Address - Fax:
Practice Address - Street 1:2410 SW AVONDALE ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5053
Practice Address - Country:US
Practice Address - Phone:304-389-2559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor