Provider Demographics
NPI:1871048066
Name:ERIC C. BURRELL
Entity type:Organization
Organization Name:ERIC C. BURRELL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:832-457-7842
Mailing Address - Street 1:2724 KIPLING ST
Mailing Address - Street 2:APT. D132
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1762
Mailing Address - Country:US
Mailing Address - Phone:832-457-7842
Mailing Address - Fax:
Practice Address - Street 1:2724 KIPLING ST
Practice Address - Street 2:APT. D132
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-1762
Practice Address - Country:US
Practice Address - Phone:832-457-7842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69981101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX358264501Medicaid