Provider Demographics
NPI:1255151122
Name:BURNS, BA'LEIGH ELIZABETH RACHEL (LPC-A, MS)
Entity type:Individual
Prefix:MISS
First Name:BA'LEIGH
Middle Name:ELIZABETH RACHEL
Last Name:BURNS
Suffix:
Gender:F
Credentials:LPC-A, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 W. BLUFF ST.
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-1352
Mailing Address - Country:US
Mailing Address - Phone:682-329-9869
Mailing Address - Fax:
Practice Address - Street 1:1810 8TH AVE # B204
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1352
Practice Address - Country:US
Practice Address - Phone:682-329-9869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91461101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor