Provider Demographics
NPI:1689996811
Name:BURRIS, CLARYCE VERNA (LCSW,CADACIV,NCAC II)
Entity Type:Individual
Prefix:MRS
First Name:CLARYCE
Middle Name:VERNA
Last Name:BURRIS
Suffix:
Gender:F
Credentials:LCSW,CADACIV,NCAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 W 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2076
Mailing Address - Country:US
Mailing Address - Phone:317-824-1725
Mailing Address - Fax:
Practice Address - Street 1:1950 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2076
Practice Address - Country:US
Practice Address - Phone:317-824-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INTO BE GRANDFATHERED101YA0400X
IN340001113A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)