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General NPI Number Information
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NPI Number | 1659446664
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Entity Type | Individual
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Provider Name | MARIE MADELEINE BURKHART M.S., LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 29 ORINDA WAY
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City | ORINDA
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State | CA
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Zip | 94563-0315
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Country | US
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Telephone | 925-528-1363
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 315
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City | ORINDA
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State | CA
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Zip | 94563-0315
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Country | US
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Telephone | 925-528-1363
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C2563
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT94533
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License Number State | CA
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