Provider Demographics
NPI:1487359477
Name:BURTON, DUSTIN TODD (MA)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:TODD
Last Name:BURTON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E FRANKLIN ROAD
Mailing Address - Street 2:STE #402
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-258-7917
Mailing Address - Fax:
Practice Address - Street 1:850 E FRANKLIN ROAD
Practice Address - Street 2:STE #402
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8364
Practice Address - Country:US
Practice Address - Phone:208-258-7917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSE-203814101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health