Doctor Name: | GERRY RYAN BURTON |
NPI Number: | 1528239829 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MS, LPC |
License Number: | LPC-1028 |
Business Practice Address: | 59 E Main St Lovell, WY - 824312001 |
Business Phone Number: | 3072724972 |
Business Fax Number: | |
Mailing Address: | Po Box 296, LOVELL |
State: | WY |
Postal Code: | 824310296 |
Phone Number: | 3072724972 |
Fax Number: | |
NPI Enumeration Date: | 03/14/2008 |
NPI Last Update Date: | 03/14/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC-1028 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |