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NPI Code Detail

MEDICARE: DR. JENNIFER BURRUEL MC, DBH

MEDICARE: DR. JENNIFER BURRUEL MC, DBH
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
1101YP2500XProfessional CounselorLPC-14129AZ
2101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LPC-14129OTHERAZLICENSED PROFESSIONAL COUNSELOR

General Provider Information

NPI Number : 1902138308
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER BURRUEL MC, DBH
Provider Business Mailing Address
First Line : 7301 N 16TH ST STE 100
Second Line :
City : PHOENIX
State : AZ
Zip : 85020-5266
Country : US
Telephone Number : 602-567-0263
Fax Number : 602-567-0263
Provider Business Practice Location Address
First Line : 7301 N 16TH ST STE 100
Second Line :
City : PHOENIX
State : AZ
Zip : 85020-5266
Country : US
Telephone Number : 602-567-0263
Fax Number : 602-567-0263
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2010
Last Update Date : 05/09/2020

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