Healthcare Provider Details

I. General information

NPI: 1801760848
Provider Name (Legal Business Name): LYNELLE RUDENE BURTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 12TH AVE S
BIRMINGHAM AL
35205-4709
US

IV. Provider business mailing address

304 62ND ST S
BIRMINGHAM AL
35212-2636
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-2430
  • Fax:
Mailing address:
  • Phone: 205-572-9619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC05739
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: