Peter K Burtis, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LMFT39126 Issued in CA

Practice address

347 Cypress St Ste a
Fort Bragg, CA 95437-5458

Phone

(707) 962-3161

Fax

(707) 937-1876

NPI assigned

May 17, 2007

Last updated

Feb 5, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bitterroot Family Therapy Inc.

  • Mental Health Counselor
  • Fort Bragg, CA
  • NPI 1003401910
  Medicare reassignment NPD
• Mendocino Coast Hospitality Center

  • Community/Behavioral Health Agency
  • Fort Bragg, CA
  • NPI 1902357437
  NPD (past)
• Redwood Community Services, Inc.

  • Mental Health Counselor
  • Willits, CA
  • NPI 1174661284

  Marriage & Family Therapist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675555200000",
    "number": "1609083609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 653",
            "city": "MENDOCINO",
            "state": "CA",
            "postal_code": "95460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "347 CYPRESS ST STE A",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375458",
            "telephone_number": "707-962-3161",
            "fax_number": "707-937-1876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURTIS",
        "first_name": "PETER",
        "middle_name": "K",
        "name_prefix": "Mr.",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2023-02-05",
        "certification_date": "2023-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT39126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609083609",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Romeo Gonzales Buison
• Sara Bulakowski
• Hannah-Leigh Bull, LMFT
• Lindsay Burkhardt, MOT
• Myra Connel Burt, PSY
• Jayne Susan Bush, FNP
• Donna Maria Call, LIC.AC
• Roy Campbell, RDA
• Sonia Castro
• Kathleen L Cave, MFT

• Marriage & Family Therapist in Fort Bragg, CA
• Providers in Fort Bragg, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.