Basic Information
| Provider Information | |||||||||
| NPI: | 1699793364 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURTON | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 9TH ST | ||||||||
| Address2: | ROOM 205 MAILSTOP 2-3 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958146414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166542431 | ||||||||
| FaxNumber: | 9166543186 | ||||||||
| Practice Location | |||||||||
| Address1: | 10333 EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | ATASCADERO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934237001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054682000 | ||||||||
| FaxNumber: | 8054666011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY14279 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC1900X | PSY14279 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TF0200X | PSY14279 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Forensic | 103T00000X | PSY14279 | CA | X | Behavioral Health & Social Service Providers | Psychologist | 103TP2701X | PSY14279 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
No ID Information.