Provider Demographics
NPI:1215074158
Name:BURRELL, TERESA LYNN (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LYNN
Last Name:BURRELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 CARRINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-7153
Mailing Address - Country:US
Mailing Address - Phone:513-275-3964
Mailing Address - Fax:
Practice Address - Street 1:205 W. FOURTH ST.
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202
Practice Address - Country:US
Practice Address - Phone:513-381-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional