Provider Demographics
NPI:1932409786
Name:BURNS, MALDA MAYO (LPC)
Entity Type:Individual
Prefix:
First Name:MALDA
Middle Name:MAYO
Last Name:BURNS
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 1:1503 SKYLES RD
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-2074
Mailing Address - Country:US
Mailing Address - Phone:512-446-6311
Mailing Address - Fax:512-446-6311
Practice Address - Street 1:1503 SKYLES RD
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2074
Practice Address - Country:US
Practice Address - Phone:512-446-6311
Practice Address - Fax:512-446-6311
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1540101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional