Provider Demographics
NPI:1447091749
Name:BURRILL, DAX (QBHP)
Entity type:Individual
Prefix:
First Name:DAX
Middle Name:
Last Name:BURRILL
Suffix:
Gender:M
Credentials:QBHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 COPPER BEECH BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-5724
Mailing Address - Country:US
Mailing Address - Phone:248-917-2042
Mailing Address - Fax:
Practice Address - Street 1:3769 QUARTON RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-4058
Practice Address - Country:US
Practice Address - Phone:248-894-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst