Dieago Ellis Burress Jr.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Practice address

5784 Fisher Dr Apt B
Huber Heights, OH 45424-5576

Phone

(937) 312-5494

NPI assigned

Aug 25, 2023

Last updated

Aug 25, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1692921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692921600000",
    "number": "1578348926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5784 FISHER DR APT B",
            "city": "HUBER HEIGHTS",
            "state": "OH",
            "postal_code": "454245576",
            "telephone_number": "937-312-5494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5784 FISHER DR APT B",
            "city": "HUBER HEIGHTS",
            "state": "OH",
            "postal_code": "454245576",
            "telephone_number": "937-312-5494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURRESS",
        "first_name": "DIEAGO",
        "middle_name": "ELLIS",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-25",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101200000X",
            "taxonomy_group": "",
            "desc": "Drama Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria E Brookshire, CFNP
• Robin Lynn Brown
• Patricia Ann Bruce
• David Buckholtz
• Wendy Bultman, RBT
• Joseph Benjamin Bush Jr.
• Lania S Bush
• Taylor Nicole Butcher, RPH
• Butler County Community Health Consortium, Inc.
• Butler County Community Health Consortium, Inc.

• Clinical Child & Adolescent Psychologist in Huber Heights, OH
• Providers in Huber Heights, OH by specialty
• Clinical Child & Adolescent Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.