Provider Demographics
NPI:1982240008
Name:BURRISS, LEESA JO (LMFT)
Entity type:Individual
Prefix:
First Name:LEESA
Middle Name:JO
Last Name:BURRISS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7905 S CHADBOURNE DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5808
Mailing Address - Country:US
Mailing Address - Phone:405-600-4406
Mailing Address - Fax:
Practice Address - Street 1:7905 S CHADBOURNE DR UNIT B
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-5808
Practice Address - Country:US
Practice Address - Phone:405-600-4406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-24
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11522450-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist