MEDICARE: MS. MITZI LOU BURTON 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	101YM0800X	Mental Health Counselor	P2102150	AR
2	101YP2500X	Professional Counselor	C5918	OR

General Provider Information

NPI Number	:	1710020334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MITZI LOU BURTON LPC

Provider Business Mailing Address
First Line	:	1720 PECAN ST
Second Line	:
City	:	TEXARKANA
State	:	AR
Zip	:	71854-4332
Country	:	US
Telephone Number	:	541-868-6254
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 PECAN ST
Second Line	:
City	:	TEXARKANA
State	:	AR
Zip	:	71854-4332
Country	:	US
Telephone Number	:	541-868-6254
Fax Number	:

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	01/15/2026

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