Provider Demographics
NPI:1457182800
Name:LAUREN BURT, A PROFESSIONAL MARRIAGE AND FAMILY THERAPY CORPORATION
Entity type:Organization
Organization Name:LAUREN BURT, A PROFESSIONAL MARRIAGE AND FAMILY THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:917-232-5620
Mailing Address - Street 1:134 W PALM ST
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-4338
Mailing Address - Country:US
Mailing Address - Phone:917-232-5620
Mailing Address - Fax:
Practice Address - Street 1:960 E GREEN ST STE L-03
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2401
Practice Address - Country:US
Practice Address - Phone:917-232-5620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty