Provider Demographics
NPI:1740201862
Name:BURTON-ALLEN, MARTHA JANE (LPCC, LICDC)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:JANE
Last Name:BURTON-ALLEN
Suffix:
Gender:F
Credentials:LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1023
Mailing Address - Country:US
Mailing Address - Phone:330-545-5214
Mailing Address - Fax:330-545-5986
Practice Address - Street 1:1537 N STATE ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1023
Practice Address - Country:US
Practice Address - Phone:330-545-5214
Practice Address - Fax:330-545-5986
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH902885101YA0400X
OHE2704101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH902885OtherLICDC
OHE2704OtherLPCC