Active NPI
Emily Sarah Burris, PH.D.
- Clinical Psychologist
- Benton Harbor, MI
National Provider Identifier
1174941918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301018775
- Practice address
- 115 W Main St
Benton Harbor, MI 49022-3663 - Phone
- (269) 934-9123
- NPI assigned
- Mar 30, 2014
- Last updated
- Aug 24, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Clinical Psychologist | 103TC0700X | 651 | WY | |
| Clinical Psychologist | 103TC0700X | 20043500B | IN | |
| Clinical Psychologist | 103TC0700X | 6301018775 | MI | Primary |
Addresses
Primary practice location
115 W Main St
Benton Harbor, MI 49022-3663
Mailing address
8467 Pucker St
Berrien Center, MI 49102-9718
Phone (419) 819-0470
Other practice location 1
University of Notre Dame
Saint
Notre Dame, IN 46556
Phone (574) 631-5643
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20043500B | IN | MD | Clinical Psychologist |
| 651 | WY | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1396137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661299200000",
"number": "1174941918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8467 PUCKER ST",
"city": "BERRIEN CENTER",
"state": "MI",
"postal_code": "491029718",
"telephone_number": "419-819-0470"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 W MAIN ST",
"city": "BENTON HARBOR",
"state": "MI",
"postal_code": "490223663",
"telephone_number": "269-934-9123"
}
],
"practiceLocations": [
{
"address_1": "University of Notre Dame",
"address_2": "Saint",
"address_purpose": "LOCATION",
"city": "Notre Dame",
"state": "IN",
"postal_code": "46556",
"country_code": "US",
"telephone_number": "574-631-5643",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BURRIS",
"first_name": "EMILY",
"middle_name": "SARAH",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-30",
"last_updated": "2022-08-24",
"certification_date": "2022-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WY",
"license": "651",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20043500B",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301018775",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Benton Harbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.