Provider Demographics
NPI:1790832905
Name:BURNETT, SHARON JEAN (MFT)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:JEAN
Last Name:BURNETT
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 1:19634 VENTURA BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2966
Mailing Address - Country:US
Mailing Address - Phone:818-609-8703
Mailing Address - Fax:818-348-9310
Practice Address - Street 1:19634 VENTURA BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2966
Practice Address - Country:US
Practice Address - Phone:818-609-8703
Practice Address - Fax:818-348-9310
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT16203106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist