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General NPI Number Information
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NPI Number | 1679809529
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Entity Type | Organization
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Legal Business Name | DUANE BURNETT
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Dates
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Enumeration Date | 10/28/2009
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Last Update Date | 10/28/2009
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Provider Practice Location Address
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Address Line | 2901 W 141ST PL SUITE 3
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City | GARDENA
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State | CA
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Zip | 90249-2763
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Country | US
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Telephone | 323-807-6940
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 W 141ST PL SUITE 3
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City | GARDENA
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State | CA
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Zip | 90249-2763
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Country | US
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Telephone | 323-807-6940
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DUANE BURNETTE
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Credential | CAS
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Telephone | 323-807-6940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 01063498
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License Number State | CA
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