MEDICARE: ERIC C. 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	101Y00000X	Counselor	69981	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871048066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIC C. BURRELL

Provider Business Mailing Address
First Line	:	2724 KIPLING ST
Second Line	:	APT. D132
City	:	HOUSTON
State	:	TX
Zip	:	77098-1762
Country	:	US
Telephone Number	:	832-457-7842
Fax Number	:

Provider Business Practice Location Address
First Line	:	2724 KIPLING ST
Second Line	:	APT. D132
City	:	HOUSTON
State	:	TX
Zip	:	77098-1762
Country	:	US
Telephone Number	:	832-457-7842
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERIC C BURRELL
Credential	:	LPC
Telephone Number	:	832-457-7842

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	08/17/2016

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