Provider Demographics
NPI:1083984025
Name:BURTON, RICHARD JEFFERSON
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JEFFERSON
Last Name:BURTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3937 SPENCER ST
Mailing Address - Street 2:APT. # 123
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5203
Mailing Address - Country:US
Mailing Address - Phone:702-475-0410
Mailing Address - Fax:
Practice Address - Street 1:3937 SPENCER ST
Practice Address - Street 2:APT. # 123
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5203
Practice Address - Country:US
Practice Address - Phone:702-475-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst