MEDICARE: MRS. JOHANNA GABRIEL BURTON LPCC

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	101YM0800X	Mental Health Counselor	LPC 0410	AZ

General Provider Information

NPI Number	:	1992753651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOHANNA GABRIEL BURTON LPCC

Provider Business Mailing Address
First Line	:	14506 W GRANITE VALLEY DRIVE
Second Line	:	SUITE #108
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-3023
Country	:	US
Telephone Number	:	623-214-1141
Fax Number	:	623-214-8903

Provider Business Practice Location Address
First Line	:	14506 W GRANITE VALLEY DRIVE
Second Line	:	SUITE #108
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-3023
Country	:	US
Telephone Number	:	623-214-1141
Fax Number	:	623-214-8903

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/08/2007

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