MEDICARE: D'ASIA 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1821756487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	D'ASIA BURRELL

Provider Business Mailing Address
First Line	:	424 W BAGLEY RD STE 216
Second Line	:
City	:	BEREA
State	:	OH
Zip	:	44017-1352
Country	:	US
Telephone Number	:	216-340-0011
Fax Number	:

Provider Business Practice Location Address
First Line	:	24570 LAKE SHORE BLVD APT 108
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-1232
Country	:	US
Telephone Number	:	216-785-4141
Fax Number	:

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

Provider Enumeration Date	:	12/01/2021
Last Update Date	:	12/01/2021

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Directions to “ D'ASIA BURRELL ” Practice Location

Language	Start Address	Practice Location

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