MEDICARE: REBECCA ASHLEY BURNS M.ED. LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	82884	TX

General Provider Information

NPI Number	:	1396414918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ASHLEY BURNS M.ED. LPC

Provider Business Mailing Address
First Line	:	300 N I 35
Second Line	:
City	:	WAXAHACHIE
State	:	TX
Zip	:	75165-5226
Country	:	US
Telephone Number	:	214-530-0021
Fax Number	:	214-530-0021

Provider Business Practice Location Address
First Line	:	101 SUMMIT AVE STE 204
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-2609
Country	:	US
Telephone Number	:	214-530-0021
Fax Number	:	214-530-0021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	09/08/2021

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