Provider Demographics
NPI:1043389968
Name:BURTON, DEIRDRE YVETTE (LMFT)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:YVETTE
Last Name:BURTON
Suffix:
Gender:F
Credentials:LMFT
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 53373
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46253-0373
Mailing Address - Country:US
Mailing Address - Phone:317-496-5484
Mailing Address - Fax:317-852-2712
Practice Address - Street 1:911 E 86TH ST STE 60
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240
Practice Address - Country:US
Practice Address - Phone:317-520-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002783A171W00000X
IN35001835A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty