Provider Demographics
NPI:1245038389
Name:BURRELL, ALMA J
Entity type:Individual
Prefix:
First Name:ALMA
Middle Name:J
Last Name:BURRELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5426 DIAMONDHEAD DR E
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-3307
Mailing Address - Country:US
Mailing Address - Phone:228-342-5776
Mailing Address - Fax:
Practice Address - Street 1:308 HIGHWAY 90 STE I
Practice Address - Street 2:
Practice Address - City:WAVELAND
Practice Address - State:MS
Practice Address - Zip Code:39576-2676
Practice Address - Country:US
Practice Address - Phone:228-342-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC11306101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty