Provider Demographics
NPI:1184021776
Name:BURCHILL, MARY F (MED, LPCC, LAC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:BURCHILL
Suffix:
Gender:F
Credentials:MED, LPCC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-2971
Mailing Address - Country:US
Mailing Address - Phone:701-840-1924
Mailing Address - Fax:
Practice Address - Street 1:333 2ND ST NW
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-2971
Practice Address - Country:US
Practice Address - Phone:701-840-1924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1681101YA0400X
ND724-8-15-12A101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health