Provider Demographics
NPI:1801237300
Name:BURTON, RUSSELL PD (PHD LMSW)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:PD
Last Name:BURTON
Suffix:
Gender:M
Credentials:PHD LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 NW KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1340
Mailing Address - Country:US
Mailing Address - Phone:785-845-6872
Mailing Address - Fax:
Practice Address - Street 1:236 NW KNOX AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1340
Practice Address - Country:US
Practice Address - Phone:785-845-6872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW 8904104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker