Provider Demographics
NPI:1730209016
Name:BURTON, MARK (PSYD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BURTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 SW BEVELAND RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8682
Mailing Address - Country:US
Mailing Address - Phone:503-807-7331
Mailing Address - Fax:
Practice Address - Street 1:7505 SW BEVELAND RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8682
Practice Address - Country:US
Practice Address - Phone:503-807-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1066103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist