Provider Demographics
NPI:1770092710
Name:BURLESON, ALEXANDRA GRACE (LPC)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:GRACE
Last Name:BURLESON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25420 KUYKENDAHL RD STE C200
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3423
Mailing Address - Country:US
Mailing Address - Phone:281-803-9822
Mailing Address - Fax:
Practice Address - Street 1:25420 KUYKENDAHL RD STE C200
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77375-3423
Practice Address - Country:US
Practice Address - Phone:281-803-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74581101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health