Provider Demographics
NPI:1194800391
Name:BURTON, DEBRA KATHLEEN (PHD,LPC,LMFT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:KATHLEEN
Last Name:BURTON
Suffix:
Gender:F
Credentials:PHD,LPC,LMFT
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 154437
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75915-4437
Mailing Address - Country:US
Mailing Address - Phone:936-639-3233
Mailing Address - Fax:936-639-3680
Practice Address - Street 1:600 S JOHN REDDITT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3121
Practice Address - Country:US
Practice Address - Phone:936-639-3233
Practice Address - Fax:936-639-3680
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1299101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004498915OtherAETNA
175133OtherVALUE OPTIONS
TX1383LCOtherBLUE CROSS BLUE SHIELD TX
240968OtherMAGELLAN