Provider Demographics
NPI:1457583197
Name:BURROWS, PENELOPE JO (MFT)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:JO
Last Name:BURROWS
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 1:369 PINE ST
Mailing Address - Street 2:SUITE 816
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3327
Mailing Address - Country:US
Mailing Address - Phone:415-263-6892
Mailing Address - Fax:707-980-7627
Practice Address - Street 1:369 PINE ST
Practice Address - Street 2:SUITE 816
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3327
Practice Address - Country:US
Practice Address - Phone:415-263-6892
Practice Address - Fax:707-980-7627
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health