Provider Demographics
NPI:1528239829
Name:BURTON, GERRY RYAN (MS, LPC)
Entity type:Individual
Prefix:
First Name:GERRY
Middle Name:RYAN
Last Name:BURTON
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-0296
Mailing Address - Country:US
Mailing Address - Phone:307-272-4972
Mailing Address - Fax:
Practice Address - Street 1:59 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOVELL
Practice Address - State:WY
Practice Address - Zip Code:82431-2001
Practice Address - Country:US
Practice Address - Phone:307-272-4972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional