Provider Demographics
NPI:1275025801
Name:BURKE, TINA (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S MELROSE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6632
Mailing Address - Country:US
Mailing Address - Phone:760-213-6559
Mailing Address - Fax:
Practice Address - Street 1:400 S MELROSE DR STE 103
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6632
Practice Address - Country:US
Practice Address - Phone:760-213-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94716106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist