Provider Demographics
NPI:1215118617
Name:BURLESON, BOBBI RENEE
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:RENEE
Last Name:BURLESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13409 MIDLAND RD APT 142
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-7703
Mailing Address - Country:US
Mailing Address - Phone:619-813-0654
Mailing Address - Fax:
Practice Address - Street 1:13409 MIDLAND RD APT 142
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-7703
Practice Address - Country:US
Practice Address - Phone:619-813-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)