MEDICARE: MR. JOHN AMOS BURT

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	LMFT140197	CA

General Provider Information

NPI Number	:	1396026274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN AMOS BURT

Provider Business Mailing Address
First Line	:	PO BOX 131
Second Line	:
City	:	LATHROP
State	:	CA
Zip	:	95330-0131
Country	:	US
Telephone Number	:	209-534-5155
Fax Number	:

Provider Business Practice Location Address
First Line	:	17000 S HARLAN RD
Second Line	:
City	:	LATHROP
State	:	CA
Zip	:	95330-8738
Country	:	US
Telephone Number	:	209-647-7609
Fax Number	:

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

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	11/14/2023

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Directions to “ MR. JOHN AMOS BURT ” Practice Location

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