Provider Demographics
NPI:1750428900
Name:BURTON, REBECCA ANN (QUALIFIED MENTAL HEA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:BURTON
Suffix:
Gender:F
Credentials:QUALIFIED MENTAL HEA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3587 HEATHROW WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4004
Mailing Address - Country:US
Mailing Address - Phone:541-858-8170
Mailing Address - Fax:541-858-8167
Practice Address - Street 1:17640 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230
Practice Address - Country:US
Practice Address - Phone:541-505-8426
Practice Address - Fax:541-515-6938
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR372600000X
372600000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No372600000XNursing Service Related ProvidersAdult Companion