Provider Demographics
NPI:1396877932
Name:BURNS, TERRI (MFT)
Entity type:Individual
Prefix:MS
First Name:TERRI
Middle Name:
Last Name:BURNS
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 1:2155 VERDUGO BLVD
Mailing Address - Street 2:P.O. BOX 520
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1628
Mailing Address - Country:US
Mailing Address - Phone:626-590-4673
Mailing Address - Fax:
Practice Address - Street 1:750 TERRADO PLZ
Practice Address - Street 2:#215
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3419
Practice Address - Country:US
Practice Address - Phone:626-590-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38250106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist