Provider Demographics
NPI:1740582980
Name:BURCH, ANGIE (MFT)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16573 LOS GATOS ALMADEN RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3536
Mailing Address - Country:US
Mailing Address - Phone:408-356-8200
Mailing Address - Fax:
Practice Address - Street 1:16573 LOS GATOS ALMADEN RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3536
Practice Address - Country:US
Practice Address - Phone:408-356-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44299106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist