Provider Demographics
NPI:1417435736
Name:BURRELL, EVELYN (PSY D)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:
Last Name:BURRELL
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 N 33RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5004
Mailing Address - Country:US
Mailing Address - Phone:602-327-4476
Mailing Address - Fax:
Practice Address - Street 1:1930 S ALMA SCHOOL RD STE B120
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3051
Practice Address - Country:US
Practice Address - Phone:602-327-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-004993103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist