Provider Demographics
NPI:1285993998
Name:BURTON, EVAN H (LMHC)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:H
Last Name:BURTON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 EDGEHILL DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-4456
Mailing Address - Country:US
Mailing Address - Phone:727-280-6822
Mailing Address - Fax:
Practice Address - Street 1:875 EDGEHILL DR
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-4456
Practice Address - Country:US
Practice Address - Phone:727-280-6822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health