Provider Demographics
NPI:1407400872
Name:BURTON, ASHLEE LAUREN (CMHC)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:LAUREN
Last Name:BURTON
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:ASHLEE
Other - Middle Name:LAUREN
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMHC
Mailing Address - Street 1:2120 S HIGHLAND DR APT 508
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3286
Mailing Address - Country:US
Mailing Address - Phone:248-326-5174
Mailing Address - Fax:
Practice Address - Street 1:155 E 900 S STE 12
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-4267
Practice Address - Country:US
Practice Address - Phone:385-212-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10854919-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10854919-6004OtherCLINICAL MENTAL HEALTH COUNSELOR
UT10854919-6009OtherASSOCIATE CLINICAL MENTAL HEALTH COUNSELOR