Provider Demographics
NPI:1427830199
Name:BURLEY, ALICIA BEATRICE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:BEATRICE
Last Name:BURLEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:BEATRICE
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2404 ELLIS ST STE 4
Mailing Address - Street 2:
Mailing Address - City:VENUS
Mailing Address - State:TX
Mailing Address - Zip Code:76084-3392
Mailing Address - Country:US
Mailing Address - Phone:817-783-0218
Mailing Address - Fax:
Practice Address - Street 1:2404 ELLIS ST STE 4
Practice Address - Street 2:
Practice Address - City:VENUS
Practice Address - State:TX
Practice Address - Zip Code:76084-3392
Practice Address - Country:US
Practice Address - Phone:817-783-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX536761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical