Provider Demographics
NPI:1902990708
Name:BURTON, MARK K (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:K
Last Name:BURTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1400 FOOTHILL DR STE 24
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2392
Mailing Address - Country:US
Mailing Address - Phone:801-581-0422
Mailing Address - Fax:801-581-0764
Practice Address - Street 1:1400 FOOTHILL DR STE 24
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2392
Practice Address - Country:US
Practice Address - Phone:801-581-0422
Practice Address - Fax:801-581-0764
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4922254-2501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling