Burris, Lydia Jeannine

Burris, Lydia Jeannine is an individual health care provider with primary practice located at 350 Salem Rd Ste 1 , Conway AR 72034-6166. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Burris, Lydia Jeannine can be contacted via phone (501) 336-8300.

Contact Information

Primary practice address
350 Salem Rd Ste 1 Conway AR 72034-6166
Phone: (501) 336-8300
Fax: (501) 329-5508
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X P0802024 Arkansas
Behavioral Health & Social Service Providers / Professional 101YP2500X P0802024 Arkansas

Profile Details

NPI number 1306027339
LBN Legal business name Burris, Lydia Jeannine
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 19th, 2007
Last updated May 1st, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306027339 NPPES
Arkansas MEDICAID 227121719

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