Healthcare Provider Details

I. General information

NPI: 1588414338
Provider Name (Legal Business Name): MARISA BURTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 ALMA DR STE 310
PLANO TX
75075-6942
US

IV. Provider business mailing address

503 PEPPERBARK AVE
PRINCETON TX
75407-0967
US

V. Phone/Fax

Practice location:
  • Phone: 303-941-5771
  • Fax:
Mailing address:
  • Phone: 303-941-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number93843
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: