Provider Demographics
NPI:1033315288
Name:BURNETTE, VANI (LMFT)
Entity Type:Individual
Prefix:
First Name:VANI
Middle Name:
Last Name:BURNETTE
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 876374
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-6374
Mailing Address - Country:US
Mailing Address - Phone:760-495-2040
Mailing Address - Fax:
Practice Address - Street 1:1585 S D ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3235
Practice Address - Country:US
Practice Address - Phone:909-388-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 51154106H00000X
CA82256106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist