Basic Information
| Provider Information | |||||||||
| NPI: | 1154086163 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURRIS | ||||||||
| FirstName: | LAUREY | ||||||||
| MiddleName: | COLLINS | ||||||||
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| Credential: | EDD, LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 291943 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372291943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8339520829 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 368 RIVER ST STE 160 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | VT | ||||||||
| PostalCode: | 051562242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8339520829 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2021 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.