Provider Demographics
NPI:1346458585
Name:WINER, BURTON N (LMFT)
Entity Type:Individual
Prefix:
First Name:BURTON
Middle Name:N
Last Name:WINER
Suffix:
Gender:M
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 631
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92781-0631
Mailing Address - Country:US
Mailing Address - Phone:714-921-1383
Mailing Address - Fax:
Practice Address - Street 1:112 E CHAPMAN AVE
Practice Address - Street 2:SUITE A5
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-1402
Practice Address - Country:US
Practice Address - Phone:714-921-1383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist