Provider Demographics
NPI:1689091035
Name:BURQUET, GISELA (LMFT)
Entity type:Individual
Prefix:
First Name:GISELA
Middle Name:
Last Name:BURQUET
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5834
Mailing Address - Street 2:
Mailing Address - City:BLUE JAY
Mailing Address - State:CA
Mailing Address - Zip Code:92317-5834
Mailing Address - Country:US
Mailing Address - Phone:213-618-1547
Mailing Address - Fax:
Practice Address - Street 1:138 N BRAND BLVD
Practice Address - Street 2:SUITE 200 UNIT#272
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203
Practice Address - Country:US
Practice Address - Phone:213-618-1547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102156106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist