Provider Demographics
NPI:1982482345
Name:BURTON, RILEY (LPC)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:BURTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:RILEY
Other - Middle Name:
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:210 W 4TH S
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83460-2020
Mailing Address - Country:US
Mailing Address - Phone:208-206-2264
Mailing Address - Fax:
Practice Address - Street 1:130 N 1ST W
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-1377
Practice Address - Country:US
Practice Address - Phone:208-351-5539
Practice Address - Fax:208-319-5561
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional