Provider Demographics
NPI:1013264498
Name:C. EMMA BURROUS, PH.D., PLC
Entity type:Organization
Organization Name:C. EMMA BURROUS, PH.D., PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:C.
Authorized Official - Middle Name:EMMA
Authorized Official - Last Name:BURROUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:802-657-4042
Mailing Address - Street 1:118 PINE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8421
Mailing Address - Country:US
Mailing Address - Phone:802-657-4042
Mailing Address - Fax:802-862-4062
Practice Address - Street 1:118 PINE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8421
Practice Address - Country:US
Practice Address - Phone:802-657-4042
Practice Address - Fax:802-862-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-05
Last Update Date:2012-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000905103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty