Provider Demographics
NPI:1952954471
Name:BURT, JOSEPH EDWARD (LPC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EDWARD
Last Name:BURT
Suffix:
Gender:M
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:PO BOX 1604
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-1604
Mailing Address - Country:US
Mailing Address - Phone:870-403-4878
Mailing Address - Fax:844-315-9561
Practice Address - Street 1:2503 PINE ST STE 4
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4368
Practice Address - Country:US
Practice Address - Phone:870-403-4878
Practice Address - Fax:844-315-9561
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1907095101Y00000X
ARP22110010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor