Provider Demographics
NPI:1679809529
Name:DUANE BURNETT
Entity Type:Organization
Organization Name:DUANE BURNETT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:CAS
Authorized Official - Phone:323-807-6940
Mailing Address - Street 1:2901 W 141ST PL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-2763
Mailing Address - Country:US
Mailing Address - Phone:323-807-6940
Mailing Address - Fax:
Practice Address - Street 1:2901 W 141ST PL
Practice Address - Street 2:SUITE 3
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-2763
Practice Address - Country:US
Practice Address - Phone:323-807-6940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01063498101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty