Provider Demographics
NPI:1205166600
Name:BURR, KENNETH ALLEN (MA, LMFT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ALLEN
Last Name:BURR
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N NORTHLAKE WAY
Mailing Address - Street 2:SUITE 127
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-9051
Mailing Address - Country:US
Mailing Address - Phone:206-219-2553
Mailing Address - Fax:206-708-1321
Practice Address - Street 1:1900 N NORTHLAKE WAY
Practice Address - Street 2:SUITE 127
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-9051
Practice Address - Country:US
Practice Address - Phone:206-219-2553
Practice Address - Fax:206-708-1321
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
WALF00001980106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral