Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY13655 | CA |
N | 103TC0700X | Clinical Psychologist | PSY13655 | CA |
N | 102L00000X | Psychologist | PSY13655 | CA |
N | 103T00000X | Psychologist | PSY13655 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY13655 | CA |
N | 103G00000X | Clinical Psychologist | PSY13655 | CA |
N | 103TC0700X | Clinical Psychologist | PSY13655 | CA |
N | 103TC1900X | Counseling Psychologist | PSY13655 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY13655 | CA |
N | 103TF0000X | Family Psychologist | PSY13655 | CA |
N | 103TH0004X | Health Psychologist | PSY13655 | CA |
N | 103TP2701X | Group Psychotherapist | PSY13655 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY13655 | CA |
NPI | 1033326459 |
---|---|
Provider Name | Clyde R Burch |
First Address | San Ramon, CA 94583-0915 |
Second Address | Danville, CA 94526-3465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NPP000 | (02) | CA |