Mr John Amos Burt, | |
17000 S Harlan Rd, Lathrop, CA 95330-8738 | |
(209) 647-7609 | |
Not Available |
Full Name | Mr John Amos Burt |
---|---|
Gender | Male |
Speciality | Marriage & Family Therapist |
Location | 17000 S Harlan Rd, Lathrop, California |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1396026274 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
106H00000X | Marriage & Family Therapist | LMFT140197 (California) | Primary |
Entity Name | Permanente Medical Group Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1073606299 PECOS PAC ID: 8921910225 Enrollment ID: O20031104000710 |
Mailing Address | Practice Location Address |
---|---|
Mr John Amos Burt, Po Box 131, Lathrop, CA 95330-0131 Ph: (209) 534-5155 | Mr John Amos Burt, 17000 S Harlan Rd, Lathrop, CA 95330-8738 Ph: (209) 647-7609 |
Ms. Vivian A Singleton, LMFT Couples Therapy Medicare: Medicare Enrolled Practice Location: 17000 S Harlan Rd, Lathrop, CA 95330 Phone: 209-647-7551 Fax: 209-647-7580 | |
Mrs. Elysa M Correia, AMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 17000 S Harlan Rd, Lathrop, CA 95330 Phone: 209-647-7600 | |
Ms. Julie Ann Williams, Couples Therapy Medicare: Medicare Enrolled Practice Location: 17000 S Harlan Rd, Lathrop, CA 95330 Phone: 209-647-7607 | |
Mrs. Amber Wilson, LMFT Couples Therapy Medicare: Medicare Enrolled Practice Location: 17000 S Harlan Rd, Lathrop, CA 95330 Phone: 209-647-7586 |