Provider Demographics
NPI:1952444903
Name:BURNETT, EDITH (MFT)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
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 1:2485 OLD EUREKA WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0336
Mailing Address - Country:US
Mailing Address - Phone:530-247-1779
Mailing Address - Fax:530-244-1546
Practice Address - Street 1:2485 OLD EUREKA WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0336
Practice Address - Country:US
Practice Address - Phone:530-247-1779
Practice Address - Fax:530-244-1546
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40708106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist