Provider Demographics
NPI:1174631600
Name:BURRIS, KENNETH E (ADDICTIONS THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:E
Last Name:BURRIS
Suffix:
Gender:M
Credentials:ADDICTIONS THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 ROSIE LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7117
Mailing Address - Country:US
Mailing Address - Phone:512-217-3781
Mailing Address - Fax:
Practice Address - Street 1:1901 S 1ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7451
Practice Address - Country:US
Practice Address - Phone:254-743-0517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)