Provider Demographics
NPI:1346568300
Name:BURNETT, LAUREL IANNE (NCC, LMHC)
Entity type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:IANNE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:NCC, LMHC
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 51561
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87181-1561
Mailing Address - Country:US
Mailing Address - Phone:505-503-5700
Mailing Address - Fax:
Practice Address - Street 1:2900 LOUISIANA BLVD NE
Practice Address - Street 2:SOUTH BUILDING, SUITE #260
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3532
Practice Address - Country:US
Practice Address - Phone:505-974-0104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0122271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health