Provider Demographics
NPI:1841358850
Name:BURRELL, NANCY BRADBURY (MPH LMHC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:BRADBURY
Last Name:BURRELL
Suffix:
Gender:F
Credentials:MPH LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077
Mailing Address - Country:US
Mailing Address - Phone:317-873-3662
Mailing Address - Fax:
Practice Address - Street 1:4833 W 106TH ST
Practice Address - Street 2:SUPER SHAPE FITNESS
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077
Practice Address - Country:US
Practice Address - Phone:317-873-3662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6741101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor