Provider Demographics
NPI:1356730469
Name:BURCH, EILEEN (LPC INTERN)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13580 WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-8482
Mailing Address - Country:US
Mailing Address - Phone:409-753-1172
Mailing Address - Fax:
Practice Address - Street 1:CARDINAL COMMUNITY CLINIC, EDUCATION BUILDING, ROOM 115
Practice Address - Street 2:BOX 10034
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77710
Practice Address - Country:US
Practice Address - Phone:409-880-7681
Practice Address - Fax:409-880-2252
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72519101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional