Healthcare Provider Details

I. General information

NPI: 1518262351
Provider Name (Legal Business Name): ELIZABETH BURCH LMLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W 8TH ST COMMUNITY HEALTH CENTER OF SOUTHEAST KANS
COFFEYVILLE KS
67337-6733
US

IV. Provider business mailing address

PO BOX 550
RIVERTON KS
66770-0550
US

V. Phone/Fax

Practice location:
  • Phone: 620-251-4300
  • Fax: 620-251-4979
Mailing address:
  • Phone: 620-848-2300
  • Fax: 620-848-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1384
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: