Provider Demographics
NPI:1255454450
Name:BURTON, FAITH LARA
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:LARA
Last Name:BURTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530351
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-0351
Mailing Address - Country:US
Mailing Address - Phone:512-923-5692
Mailing Address - Fax:
Practice Address - Street 1:1111 N 7TH ST
Practice Address - Street 2:STE. A
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-5099
Practice Address - Country:US
Practice Address - Phone:956-289-7000
Practice Address - Fax:956-289-7257
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health