Healthcare Provider Details

I. General information

NPI: 1861203168
Provider Name (Legal Business Name): EMMA RAE BURTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 SE TECH CENTER PL STE 300
VANCOUVER WA
98683-5509
US

IV. Provider business mailing address

522 W RIVERSIDE AVE # 8096
SPOKANE WA
99201-0580
US

V. Phone/Fax

Practice location:
  • Phone: 971-319-3053
  • Fax:
Mailing address:
  • Phone: 503-662-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC.LH.70149426
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: