Individual provider · NPI-1

Larry W Burnham Jr., LPT

Licensed Psychiatric Technician · Santa Maria, CA

NPI number1467525667
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1467525667
Entity type
Individual (NPI-1)
Name
Mr. Larry W Burnham Jr.
Credential
LPT
Sex
Male
Sole proprietor
No
Enumeration date
Nov 16, 2006
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
167G00000X Licensed Psychiatric TechnicianPT32249CAYes

Practice location

500 W Foster Rd
Santa Maria, CA 93455-3620

Phone 805-934-6380

Mailing address

500 W Foster Rd
Santa Maria, CA 93455-3620

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