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General NPI Number Information
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NPI Number | 1073284022
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Entity Type | Individual
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Provider Name | TRACEY LEIGH BURNETT-GREENUP LPC
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Gender | Female
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Dates
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Enumeration Date | 09/21/2021
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 2041 PEMBROKE BAY DR
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City | LEAGUE CITY
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State | TX
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Zip | 77573-3937
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Country | US
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Telephone | 713-542-6424
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Fax |
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Provider Business Mailing Address
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Address Line | 2041 PEMBROKE BAY DR
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City | LEAGUE CITY
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State | TX
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Zip | 77573-3937
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Country | US
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Telephone | 713-542-6424
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 83675
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License Number State | TX
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