Provider Demographics
NPI:1336613728
Name:EDDIE BURL LLC
Entity Type:Organization
Organization Name:EDDIE BURL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:701-936-1342
Mailing Address - Street 1:3707 BELL BLVD E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8503
Mailing Address - Country:US
Mailing Address - Phone:701-936-1342
Mailing Address - Fax:
Practice Address - Street 1:1351 PAGE DR S STE 203
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3536
Practice Address - Country:US
Practice Address - Phone:701-936-1342
Practice Address - Fax:701-639-7207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty