Healthcare Provider Details

I. General information

NPI: 1104612092
Provider Name (Legal Business Name): CHRISTOPHER BURNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 LANGSDORF DR STE 108
FULLERTON CA
92831-3702
US

IV. Provider business mailing address

1628 E AMAR RD APT L
WEST COVINA CA
91792-1622
US

V. Phone/Fax

Practice location:
  • Phone: 714-926-4502
  • Fax:
Mailing address:
  • Phone: 626-587-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: