Provider Demographics
NPI:1346740388
Name:BURRELL, KRISTY L (BS)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:L
Last Name:BURRELL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 JOSEPHINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70113-2444
Mailing Address - Country:US
Mailing Address - Phone:504-390-9949
Mailing Address - Fax:
Practice Address - Street 1:2316 JOSEPHINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-2444
Practice Address - Country:US
Practice Address - Phone:504-390-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health