Provider Demographics
NPI:1003351719
Name:BURNLEY, TARA (LMFT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BURNLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41543
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93140-1543
Mailing Address - Country:US
Mailing Address - Phone:805-570-3741
Mailing Address - Fax:
Practice Address - Street 1:3160 TELEGRAPH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3233
Practice Address - Country:US
Practice Address - Phone:805-570-3741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96648106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist