Provider Demographics
NPI:1770202715
Name:BURISH, EMILY (PHD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BURISH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 JOHN DAY DR UNIT 202
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-6021
Mailing Address - Country:US
Mailing Address - Phone:920-629-7949
Mailing Address - Fax:
Practice Address - Street 1:1900 NE 3RD ST STE 106-1019
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3894
Practice Address - Country:US
Practice Address - Phone:775-297-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3729103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling