1992753651 NPI number — MRS. JOHANNA GABRIEL BURTON LPCC

Table of content: MRS. JOHANNA GABRIEL BURTON LPCC (NPI 1992753651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992753651 NPI number — MRS. JOHANNA GABRIEL BURTON LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURTON
Provider First Name:
JOHANNA
Provider Middle Name:
GABRIEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KANTOR-BURTON
Provider Other First Name:
JOAN
Provider Other Middle Name:
DOLORES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992753651
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:
14506 W GRANITE VALLEY DRIVE
Provider Second Line Business Mailing Address:
SUITE #108
Provider Business Mailing Address City Name:
SUN CITY WEST
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85375-3023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-214-1141
Provider Business Mailing Address Fax Number:
623-214-8903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14506 W GRANITE VALLEY DRIVE
Provider Second Line Business Practice Location Address:
SUITE #108
Provider Business Practice Location Address City Name:
SUN CITY WEST
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85375-3023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-214-1141
Provider Business Practice Location Address Fax Number:
623-214-8903
Provider Enumeration Date:
05/05/2006

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: 101YM0800X , with the licence number:  LPC 0410 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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