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General NPI Number Information
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NPI Number | 1790880839
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Entity Type | Individual
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Provider Name | JOHN W BURT PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 255 LINDEN ST SUITE 202
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City | FORT COLLINS
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State | CO
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Zip | 80524-4435
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Country | US
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Telephone | 970-482-4334
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Fax | 970-407-1339
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Provider Business Mailing Address
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Address Line | 255 LINDEN ST SUITE 202
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City | FORT COLLINS
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State | CO
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Zip | 80524-4435
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Country | US
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Telephone | 970-482-4334
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Fax | 970-407-1339
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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 | 2055
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License Number State | CO
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