Provider Demographics
NPI:1902138308
Name:BURRUEL, JENNIFER (MC, DBH)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:BURRUEL
Suffix:
Gender:F
Credentials:MC, DBH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 N 16TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5266
Mailing Address - Country:US
Mailing Address - Phone:602-567-0263
Mailing Address - Fax:602-567-0263
Practice Address - Street 1:7301 N 16TH ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5266
Practice Address - Country:US
Practice Address - Phone:602-567-0263
Practice Address - Fax:602-567-0263
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-14129101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-14129OtherLICENSED PROFESSIONAL COUNSELOR