Provider Demographics
NPI:1174216360
Name:MARTHA BURTON-ALLEN
Entity type:Organization
Organization Name:MARTHA BURTON-ALLEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURTON-ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LICDC
Authorized Official - Phone:330-545-5214
Mailing Address - Street 1:1537 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1023
Mailing Address - Country:US
Mailing Address - Phone:330-545-5214
Mailing Address - Fax:330-545-5986
Practice Address - Street 1:1537 N STATE ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1023
Practice Address - Country:US
Practice Address - Phone:330-545-5214
Practice Address - Fax:330-545-5986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty