Provider Demographics
NPI:1548919855
Name:BURRIS, JOSEPH BENTON JR (PEER SUPPORT SPECIAL)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BENTON
Last Name:BURRIS
Suffix:JR
Gender:M
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13390 AVENUE 26
Mailing Address - Street 2:
Mailing Address - City:CHOWCHILLA
Mailing Address - State:CA
Mailing Address - Zip Code:93610-9321
Mailing Address - Country:US
Mailing Address - Phone:559-232-1864
Mailing Address - Fax:
Practice Address - Street 1:13390 AVENUE 26
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-9321
Practice Address - Country:US
Practice Address - Phone:559-232-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist