Provider Demographics
NPI:1447314844
Name:BURTON, CASEY LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:LYNN
Last Name:BURTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:LYNN
Other - Last Name:MOHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:189 S STATE ST STE 245
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1001
Mailing Address - Country:US
Mailing Address - Phone:385-393-0055
Mailing Address - Fax:
Practice Address - Street 1:189 S STATE ST STE 245
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1001
Practice Address - Country:US
Practice Address - Phone:385-393-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5935386-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT876000308007Medicaid
UT260022408OtherRAILROAD MEDICARE
UT000055266Medicare ID - Type UnspecifiedMEDICARE