MEDICARE: TERESA ANN BURTON LPC LSAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2864066004	UT

General Provider Information

NPI Number	:	1245531862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ANN BURTON LPC LSAC

Provider Business Mailing Address
First Line	:	11075 S STATE ST STE 35
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-5187
Country	:	US
Telephone Number	:	801-867-6550
Fax Number	:	801-501-7317

Provider Business Practice Location Address
First Line	:	223 S 700 E STE 1
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2172
Country	:	US
Telephone Number	:	801-867-6550
Fax Number	:	801-501-7317

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2010
Last Update Date	:	08/24/2023

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