Provider Demographics
NPI:1760896393
Name:BURKS, BARBARA DIANE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:DIANE
Last Name:BURKS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21744 CASSEL RD
Mailing Address - Street 2:
Mailing Address - City:CASSEL
Mailing Address - State:CA
Mailing Address - Zip Code:96016-9529
Mailing Address - Country:US
Mailing Address - Phone:530-335-4713
Mailing Address - Fax:
Practice Address - Street 1:37104 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013-4127
Practice Address - Country:US
Practice Address - Phone:530-335-3335
Practice Address - Fax:530-232-2289
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT111511106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist