MEDICARE: SELENE BURLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1326573015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELENE BURLEY

Provider Business Mailing Address
First Line	:	73550 ALESSANDRO DR STE 200
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3613
Country	:	US
Telephone Number	:	760-459-4047
Fax Number	:

Provider Business Practice Location Address
First Line	:	73550 ALESSANDRO DR STE 200
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3613
Country	:	US
Telephone Number	:	760-459-4047
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2017
Last Update Date	:	10/14/2021

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Directions to “ SELENE BURLEY ” Practice Location

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