Provider Demographics
NPI:1518572155
Name:LORENTZEN, BURKLEY ELIZABETH
Entity Type:Individual
Prefix:
First Name:BURKLEY
Middle Name:ELIZABETH
Last Name:LORENTZEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 FOWLER DR
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2503
Mailing Address - Country:US
Mailing Address - Phone:612-306-7760
Mailing Address - Fax:
Practice Address - Street 1:5750 DIVISION ST STE 104
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3259
Practice Address - Country:US
Practice Address - Phone:951-900-6390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst