Healthcare Provider Details

I. General information

NPI: 1710020334
Provider Name (Legal Business Name): MITZI LOU BURTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 PECAN ST
TEXARKANA AR
71854-4332
US

IV. Provider business mailing address

1720 PECAN ST
TEXARKANA AR
71854-4332
US

V. Phone/Fax

Practice location:
  • Phone: 541-868-6254
  • Fax:
Mailing address:
  • Phone: 541-868-6254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5918
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2102150
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: