Provider Demographics
NPI:1669109799
Name:BURDT, CARLA RENEE (CCHT)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:RENEE
Last Name:BURDT
Suffix:
Gender:F
Credentials:CCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41765 RIDER WAY
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4826
Mailing Address - Country:US
Mailing Address - Phone:619-209-0107
Mailing Address - Fax:
Practice Address - Street 1:41765 RIDER WAY
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4826
Practice Address - Country:US
Practice Address - Phone:951-327-5347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health