Provider Demographics
NPI:1487390266
Name:BURCH, IMELDA MELY (LPC)
Entity type:Individual
Prefix:
First Name:IMELDA
Middle Name:MELY
Last Name:BURCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 AVENUE I SE
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-6822
Mailing Address - Country:US
Mailing Address - Phone:940-585-8483
Mailing Address - Fax:
Practice Address - Street 1:608 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201-3739
Practice Address - Country:US
Practice Address - Phone:806-447-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health