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Individual

IVEY LOUISE BURTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
450 BAUCHET ST, LOS ANGELES, CA 90012-2907
(213) 473-6111
Mailing address
450 BAUCHET ST, LOS ANGELES, CA 90012-2907
(213) 473-6111

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY14900
CA
103T00000X
Psychologist
103TH0100X
Health Service Psychologist
PSY14900
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
UNKNOWN
UNKNOWN
Enumeration date
05/05/2022
Last updated
05/05/2022
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