Provider Demographics
NPI:1568065670
Name:BURTON, DERRICK DAMONE
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:DAMONE
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 1:2703 SUN VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2792
Mailing Address - Country:US
Mailing Address - Phone:832-994-0072
Mailing Address - Fax:
Practice Address - Street 1:2703 SUN VALLEY CT
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2792
Practice Address - Country:US
Practice Address - Phone:832-994-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health