Provider Demographics
NPI:1790862811
Name:BURNETT, MARY SELLERS (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SELLERS
Last Name:BURNETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1807 YUILLE LN
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4651
Mailing Address - Country:US
Mailing Address - Phone:251-377-0168
Mailing Address - Fax:251-621-9737
Practice Address - Street 1:1110 MONTLIMAR DR STE 190
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1730
Practice Address - Country:US
Practice Address - Phone:251-377-0168
Practice Address - Fax:251-621-9737
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1093101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional