Healthcare Provider Details

I. General information

NPI: 1427405950
Provider Name (Legal Business Name): ELIZABETH ANN BURROUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 THE ALAMEDA
SAN JOSE CA
95126-1457
US

IV. Provider business mailing address

1922 THE ALAMEDA STE 316
SAN JOSE CA
95126-1461
US

V. Phone/Fax

Practice location:
  • Phone: 408-261-7777
  • Fax:
Mailing address:
  • Phone: 408-261-7777
  • Fax: 408-642-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: