Provider Demographics
NPI:1699247965
Name:BURKE, AMY LYONS (MED, ALC, NCC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYONS
Last Name:BURKE
Suffix:
Gender:F
Credentials:MED, ALC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 COALES BRANCH CIR
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-4851
Mailing Address - Country:US
Mailing Address - Phone:205-913-3050
Mailing Address - Fax:
Practice Address - Street 1:2127 14TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3900
Practice Address - Country:US
Practice Address - Phone:205-913-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3171A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor