Provider Demographics
NPI:1417991498
Name:HONESCKO, BURDETTA LOUISE (MFT, PSY D)
Entity Type:Individual
Prefix:DR
First Name:BURDETTA
Middle Name:LOUISE
Last Name:HONESCKO
Suffix:
Gender:F
Credentials:MFT, PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5326 E WESTRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3728
Mailing Address - Country:US
Mailing Address - Phone:714-998-1914
Mailing Address - Fax:714-921-9812
Practice Address - Street 1:2900 BRISTOL ST
Practice Address - Street 2:J101
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5981
Practice Address - Country:US
Practice Address - Phone:714-998-1914
Practice Address - Fax:714-921-9812
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT25579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health