Carrie A Burris, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

5619 Issued in ND

Practice address

24 W Railroad Ave Suite 16
Ray, ND 58849

Phone

(701) 568-5600

NPI assigned

May 28, 2013

Last updated

May 21, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northwest Behavioral Health Clinic

  • Adult Mental Health Clinic/Center
  • Williston, ND
  • NPI 1770524613
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558396800000",
    "number": "1053758300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 14TH ST W STE 290",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588014078",
            "telephone_number": "701-334-6442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 W RAILROAD AVE SUITE 16",
            "city": "RAY",
            "state": "ND",
            "postal_code": "58849",
            "telephone_number": "701-568-5600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "380 N Capital Ave",
            "address_purpose": "LOCATION",
            "city": "Idaho Falls",
            "state": "ID",
            "postal_code": "834023633",
            "country_code": "US",
            "telephone_number": "208-881-5059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURRIS",
        "first_name": "CARRIE",
        "middle_name": "A",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-28",
        "last_updated": "2019-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-35774",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ND",
            "license": "5619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND BOARD OF SW EXAMINERS",
            "identifier": "5619",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ID BUREAU OF OCCUPATIONAL LICENSES",
            "identifier": "LCSW-35774",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heidi L Barman
• Community Chiropractic Center
• Chelsie Haaland, M.S., CCC-SLP
• Brenna L Hudson, PA-C
• Melissa Margaret Miesaloski, RN
• Anne-Louise Irene Morgan

• Clinical Social Worker in Ray, ND
• Providers in Ray, ND by specialty
• Clinical Social Worker in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.