=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134479157
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRICIA BURTON LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2012
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9200 W CROSS DR STE 203
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80123-2225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-810-5513
-----------------------------------------------------
Fax | 303-810-5513
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5129 S ZANG WAY
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80127-1501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-810-5513
-----------------------------------------------------
Fax | 720-398-3126
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6120
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------