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General NPI Number Information
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NPI Number | 1518210079
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Entity Type | Individual
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Provider Name | ELVIN THOMASEO BURTON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 51 N DUNLAP ST STE. G145
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City | MEMPHIS
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State | TN
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Zip | 38105-4625
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Country | US
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Telephone | 901-287-5565
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Fax |
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Provider Business Mailing Address
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Address Line | 186 MARKET ST # 310
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City | MEMPHIS
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State | TN
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Zip | 38105-3537
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Country | US
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Telephone | 617-445-1579
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3295
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 9642
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS019677
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License Number State | PA
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