Provider Demographics
NPI:1114168747
Name:FURSE, ROBERT (MFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:FURSE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 N CAMDEN DR STE 105
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4422
Mailing Address - Country:US
Mailing Address - Phone:310-552-5778
Mailing Address - Fax:
Practice Address - Street 1:409 N CAMDEN DR STE 105
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4422
Practice Address - Country:US
Practice Address - Phone:310-552-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist