Provider Demographics
NPI:1154708279
Name:BUERKLIN, EUGENIA (MFT)
Entity type:Individual
Prefix:
First Name:EUGENIA
Middle Name:
Last Name:BUERKLIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15435 STARE ST
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2919
Mailing Address - Country:US
Mailing Address - Phone:818-679-2599
Mailing Address - Fax:
Practice Address - Street 1:6506 MCLENNAN AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-5537
Practice Address - Country:US
Practice Address - Phone:818-679-2599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86407106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist