Individual
MRS. LYDIA JEANNINE BURRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
350 SALEM RD STE 1, CONWAY, AR 72034-6166
(501) 336-8300
(501) 329-5508
Mailing address
2400 S 48TH ST, SPRINGDALE, AR 72762-6683
(479) 750-2020
(479) 750-4843
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
P0802024
AR
101YP2500X
Professional Counselor
Primary
P0802024
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227121719
—
AR
Enumeration date
11/19/2007
Last updated
05/01/2020
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