Provider Demographics
NPI:1245531862
Name:BURTON, TERESA ANN (LPC LSAC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:BURTON
Suffix:
Gender:F
Credentials:LPC LSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11075 S STATE ST STE 35
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5187
Mailing Address - Country:US
Mailing Address - Phone:801-867-6550
Mailing Address - Fax:801-501-7317
Practice Address - Street 1:223 S 700 E STE 1
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2172
Practice Address - Country:US
Practice Address - Phone:801-867-6550
Practice Address - Fax:801-501-7317
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2864066004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional