Individual
MR. LARRY W BURNHAM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
500 W FOSTER RD, SANTA MARIA, CA 93455-3620
(805) 934-6380
Mailing address
500 W FOSTER RD, SANTA MARIA, CA 93455-3620
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT32249
CA
Other
Enumeration date
11/16/2006
Last updated
07/08/2007
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