Provider Demographics
NPI:1710570809
Name:BURTON, RICHARD YATES (CA LMFT 40846)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:YATES
Last Name:BURTON
Suffix:
Gender:M
Credentials:CA LMFT 40846
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8205 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-2255
Mailing Address - Country:US
Mailing Address - Phone:415-225-5787
Mailing Address - Fax:
Practice Address - Street 1:8205 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-2255
Practice Address - Country:US
Practice Address - Phone:415-225-5787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40846106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty