Provider Demographics
NPI:1164592788
Name:BURNS, J THOMAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:THOMAS
Last Name:BURNS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18000 STUDEBAKER RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2684
Mailing Address - Country:US
Mailing Address - Phone:562-467-8944
Mailing Address - Fax:562-924-1804
Practice Address - Street 1:18000 STUDEBAKER RD
Practice Address - Street 2:SUITE 700
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2684
Practice Address - Country:US
Practice Address - Phone:562-467-8944
Practice Address - Fax:562-924-1804
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7004103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
JBCP7004Medicare ID - Type Unspecified