Provider Demographics
NPI:1801230651
Name:ASHWORTH, BURTON (PHD (ABD))
Entity type:Individual
Prefix:
First Name:BURTON
Middle Name:
Last Name:ASHWORTH
Suffix:
Gender:M
Credentials:PHD (ABD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3246
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-3246
Mailing Address - Country:US
Mailing Address - Phone:337-310-0153
Mailing Address - Fax:337-310-0202
Practice Address - Street 1:3501 5TH AVE
Practice Address - Street 2:STE A
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-2155
Practice Address - Country:US
Practice Address - Phone:337-310-0153
Practice Address - Fax:337-310-0202
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist