Provider Demographics
NPI:1194397703
Name:BURNS, ERIELLA MARIE
Entity Type:Individual
Prefix:
First Name:ERIELLA
Middle Name:MARIE
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12319 HIGHLAND RD STE 501
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2946
Mailing Address - Country:US
Mailing Address - Phone:810-991-1211
Mailing Address - Fax:810-991-1656
Practice Address - Street 1:202 PINE ST
Practice Address - Street 2:
Practice Address - City:CHESANING
Practice Address - State:MI
Practice Address - Zip Code:48616-1252
Practice Address - Country:US
Practice Address - Phone:989-323-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician