Healthcare Provider Details

I. General information

NPI: 1174842207
Provider Name (Legal Business Name): JOY DIANE BURRIS M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JOY DIANE HANSFORD

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 S US HIGHWAY 41
TERRE HAUTE IN
47802-4749
US

IV. Provider business mailing address

6401 S US HIGHWAY 41
TERRE HAUTE IN
47802-4749
US

V. Phone/Fax

Practice location:
  • Phone: 812-299-1156
  • Fax: 812-298-3291
Mailing address:
  • Phone: 812-299-1156
  • Fax: 812-298-3291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: