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NPI Code Detail

MEDICARE: TOMMIE DEMOND BURRELL LCSW

MEDICARE: TOMMIE DEMOND BURRELL LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker56617TX

General Provider Information

NPI Number : 1417716986
Entity Type Code : Individual
Provider Name (Legal Business Name) : TOMMIE DEMOND BURRELL LCSW
Provider Business Mailing Address
First Line : 3363 MCCUE RD APT 220
Second Line :
City : HOUSTON
State : TX
Zip : 77056-6768
Country : US
Telephone Number : 832-316-1182
Fax Number :
Provider Business Practice Location Address
First Line : 3363 MCCUE RD APT 220
Second Line :
City : HOUSTON
State : TX
Zip : 77056-6768
Country : US
Telephone Number : 832-316-1182
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2024
Last Update Date : 03/18/2024

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