Provider Demographics
NPI:1215426309
Name:BURTON, HEATHER LAURA (BA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LAURA
Last Name:BURTON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3595 NW 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1631
Mailing Address - Country:US
Mailing Address - Phone:863-532-8457
Mailing Address - Fax:
Practice Address - Street 1:3595 NW 15TH AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1631
Practice Address - Country:US
Practice Address - Phone:863-532-8457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health