Provider Demographics
NPI:1598340986
Name:BURRELL PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:BURRELL PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:602-327-4476
Mailing Address - Street 1:3821 N 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5545
Mailing Address - Country:US
Mailing Address - Phone:602-327-4476
Mailing Address - Fax:
Practice Address - Street 1:3821 N 15TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-5545
Practice Address - Country:US
Practice Address - Phone:602-327-4476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty