Provider Demographics
NPI:1164913737
Name:BURRELL, ERIN ELIZABETH (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:ELIZABETH
Last Name:BURRELL
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 JACKSON PL
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1457
Mailing Address - Country:US
Mailing Address - Phone:773-870-9079
Mailing Address - Fax:
Practice Address - Street 1:1118 JACKSON PL
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1457
Practice Address - Country:US
Practice Address - Phone:773-870-9079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-19
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042902A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical