Provider Demographics
NPI:1639295520
Name:BURTON, JOHN C (PSYD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
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:PO BOX 2022
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1929
Mailing Address - Country:US
Mailing Address - Phone:541-288-8096
Mailing Address - Fax:415-500-8275
Practice Address - Street 1:1100 E MARINA WAY
Practice Address - Street 2:SUITE 221
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2305
Practice Address - Country:US
Practice Address - Phone:541-288-8096
Practice Address - Fax:415-500-8275
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2631103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
9968OtherSFGH INTERNAL USE ONLY
9968OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER