Individual
PHILIP BURTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4470 W 78TH STREET CIR STE 267, BLOOMINGTON, MN 55435-5408
(612) 424-5536
Mailing address
8131 34TH AVE S APT 425, BLOOMINGTON, MN 55425-1699
(612) 424-5536
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
301962
LADC LICENSE
MN
Enumeration date
06/06/2019
Last updated
11/03/2025
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