1861466765 NPI number — MS. MAXINE DEE BURTON LCSW

Table of content: MS. MAXINE DEE BURTON LCSW (NPI 1861466765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861466765 NPI number — MS. MAXINE DEE BURTON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURTON
Provider First Name:
MAXINE
Provider Middle Name:
DEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861466765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4550 KRUSE WAY
Provider Second Line Business Mailing Address:
STE 225
Provider Business Mailing Address City Name:
LAKE OSWEGO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-635-1446
Provider Business Mailing Address Fax Number:
503-635-0583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4550 KRUSE WAY
Provider Second Line Business Practice Location Address:
STE 225
Provider Business Practice Location Address City Name:
LAKE OSWEGO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-635-1446
Provider Business Practice Location Address Fax Number:
503-635-0583
Provider Enumeration Date:
02/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  1755 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)