Provider Demographics
NPI:1992753651
Name:BURTON, JOHANNA GABRIEL (LPCC)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:GABRIEL
Last Name:BURTON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:DOLORES
Other - Last Name:KANTOR-BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:14506 W GRANITE VALLEY DRIVE
Mailing Address - Street 2:SUITE #108
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-3023
Mailing Address - Country:US
Mailing Address - Phone:623-214-1141
Mailing Address - Fax:623-214-8903
Practice Address - Street 1:14506 W GRANITE VALLEY DRIVE
Practice Address - Street 2:SUITE #108
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-3023
Practice Address - Country:US
Practice Address - Phone:623-214-1141
Practice Address - Fax:623-214-8903
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 0410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health