Provider Demographics
NPI:1588073407
Name:BURCHARD, STEPHEN RAY (CADCA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RAY
Last Name:BURCHARD
Suffix:
Gender:M
Credentials:CADCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68625 PEREZ RD STE 5
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-7250
Mailing Address - Country:US
Mailing Address - Phone:760-773-6768
Mailing Address - Fax:760-773-6808
Practice Address - Street 1:68625 PEREZ RD STE 5
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-7250
Practice Address - Country:US
Practice Address - Phone:760-773-6768
Practice Address - Fax:760-773-6808
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-B1205090846101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)