MEDICARE: MAUTRICE BURRELL

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
1	106S00000X	Behavior Technician	RBT6077	NV
2	1041C0700X	Clinical Social Worker	12099-M	NV

General Provider Information

NPI Number	:	1912308867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUTRICE BURRELL

Provider Business Mailing Address
First Line	:	4344 W CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2484
Country	:	US
Telephone Number	:	702-675-6314
Fax Number	:

Provider Business Practice Location Address
First Line	:	4344 W CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2484
Country	:	US
Telephone Number	:	702-675-6314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2014
Last Update Date	:	03/06/2026

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Directions to “ MAUTRICE BURRELL ” Practice Location

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