Provider Demographics
NPI:1699298059
Name:BURT, BURTON (LMHC, MCAP, SAP)
Entity type:Individual
Prefix:
First Name:BURTON
Middle Name:
Last Name:BURT
Suffix:
Gender:M
Credentials:LMHC, MCAP, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7014 SW COUNTY ROAD 796
Mailing Address - Street 2:
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054-5539
Mailing Address - Country:US
Mailing Address - Phone:352-440-6622
Mailing Address - Fax:
Practice Address - Street 1:5550 NW 111TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-9711
Practice Address - Country:US
Practice Address - Phone:352-440-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FL22439101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor