Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 091LB1326 011909 | TX |
NPI | 1124473442 |
---|---|
Provider Name | Dr. Lisa Burroughs |
First Address | College Station, TX 77840-6159 |
Second Address | Bryan, TX 77802-2751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2016 |
Last Update Date | 25/04/2016 |