Henry Burciaga, MFT
Individual provider Active NPI Marriage & Family Therapist · Beaumont, CA
NPI 1487785705 · NPPES record last updated Apr 2, 2018
Key facts
- NPI
- 1487785705
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- MFT19940 (CA)
- Practice address
- 14700 Manzanita Rd
Beaumont, CA 92223-3026 - Phone
- (951) 845-3155
- Fax
- (951) 845-8412
- NPI assigned
- Mar 8, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC19940 | CA | MD | Marriage & Family Therapist |
| MFT19940 | CA | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC19940 | CA | |
| Marriage & Family Therapist | 106H00000X | |||
| Marriage & Family Therapist | 106H00000X | MFT19940 | CA | Yes |
Addresses
Primary practice location
14700 Manzanita Rd
Beaumont, CA 92223-3026
Mailing address
27555 E Trail Ridge Way Apt 1094
Moreno Valley, CA 92555-4491
Phone (310) 908-8379
Other practice location 1
27555 E Trail Ridge Way Apt 1094
Moreno Valley, CA 92555-4491
Phone (310) 908-8379
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00007300 | Medicaid | CA |
Other providers in Beaumont, CA
- Angela Brady
- Miranda Elizabeth Bravo Alkaddumi
- Michelle Marie Brilee
- Sarah Elise Brownfield
- Mae Buenafe
- Melanie Burmeister
- Latanya Arlecia Busby
- C.H.a.R.L.E.E. Family Care, Inc.
- Alexis Calderon
- Brittany Ann Calderon
All providers in Beaumont, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.