Provider Demographics
NPI:1356358642
Name:BURNS, KATHLEEN ODELL (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ODELL
Last Name:BURNS
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:ODELL
Other - Last Name:BURNS-STANTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3110 CAMINO DEL RIO S STE 219
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3831
Mailing Address - Country:US
Mailing Address - Phone:619-280-6622
Mailing Address - Fax:619-441-1225
Practice Address - Street 1:3110 CAMINO DEL RIO S STE 219
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3831
Practice Address - Country:US
Practice Address - Phone:619-280-6622
Practice Address - Fax:619-441-1225
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC15803106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist