Provider Demographics
NPI:1255739017
Name:BURRELL-SMITH, JULIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:BURRELL-SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 S MICHIGAN AVE
Mailing Address - Street 2:2100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3357
Mailing Address - Country:US
Mailing Address - Phone:312-344-1081
Mailing Address - Fax:312-488-4624
Practice Address - Street 1:8 S MICHIGAN AVE
Practice Address - Street 2:2100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3357
Practice Address - Country:US
Practice Address - Phone:312-344-1081
Practice Address - Fax:312-488-4624
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008962103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical