MEDICARE: KIANA LATISHA BURCHETT M.S, LPC-A

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	171M00000X	Case Manager/Care Coordinator
2	101YP2500X	Professional Counselor	91151	TX

General Provider Information

NPI Number	:	1477139400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIANA LATISHA BURCHETT M.S, LPC-A

Provider Business Mailing Address
First Line	:	2600 GESSNER RD STE 203
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-3843
Country	:	US
Telephone Number	:	832-639-4095
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 GESSNER RD STE 203
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-3843
Country	:	US
Telephone Number	:	713-969-8964
Fax Number	:

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

Provider Enumeration Date	:	03/21/2021
Last Update Date	:	11/09/2023

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