Provider Demographics
NPI:1720428584
Name:BURTON, KIMBERLY AHN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:AHN
Last Name:BURTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 QUAIL LAKES DR STE C-5
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6471
Mailing Address - Country:US
Mailing Address - Phone:209-406-2538
Mailing Address - Fax:
Practice Address - Street 1:4750 QUAIL LAKES DR STE C-5
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6471
Practice Address - Country:US
Practice Address - Phone:209-406-2538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF62967106H00000X
CA116284106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist