Provider Demographics
NPI:1528139268
Name:BURIK, NICOLE ANNE (MFT)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ANNE
Last Name:BURIK
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 1:5122 KATELLA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6835
Mailing Address - Country:US
Mailing Address - Phone:562-431-8822
Mailing Address - Fax:
Practice Address - Street 1:5122 KATELLA AVE STE 201
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6835
Practice Address - Country:US
Practice Address - Phone:562-431-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40524106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist