Provider Demographics
NPI:1164996484
Name:BURRELL, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BURRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 N 179TH DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-5201
Mailing Address - Country:US
Mailing Address - Phone:623-229-4755
Mailing Address - Fax:623-321-8145
Practice Address - Street 1:854 S SUNSET AVE
Practice Address - Street 2:
Practice Address - City:SOMERTON
Practice Address - State:AZ
Practice Address - Zip Code:85350-5005
Practice Address - Country:US
Practice Address - Phone:602-367-5345
Practice Address - Fax:623-321-8145
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5622251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health