Provider Demographics
NPI:1679744577
Name:BURAU, MARY LOUISE (MFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LOUISE
Last Name:BURAU
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:MARIE
Other - Middle Name:LOUISE
Other - Last Name:BURAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:1911 WILLIAMS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2665
Mailing Address - Country:US
Mailing Address - Phone:805-981-4200
Mailing Address - Fax:805-981-3341
Practice Address - Street 1:1911 WILLIAMS DR STE 110
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2665
Practice Address - Country:US
Practice Address - Phone:805-981-4200
Practice Address - Fax:805-981-3341
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45378101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health