Provider Demographics
NPI:1659705242
Name:BURGESS, ALLISON LEE (LMFT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:BURGESS
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:869 VIA DE LA PAZ STE D
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-5236
Mailing Address - Country:US
Mailing Address - Phone:310-741-1391
Mailing Address - Fax:
Practice Address - Street 1:11911 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5086
Practice Address - Country:US
Practice Address - Phone:424-265-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90705106H00000X
ORT1850106H00000X
CAMFTI 68112106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist