Phillip D Burrill

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

84557 Issued in CA

Practice address

2225 Challenger Way
Santa Rosa, CA 95407-5441

Phone

(707) 565-3410

Fax

(707) 565-6914

NPI assigned

Jan 15, 2010

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

Opted out of Medicare

Yes, effective Nov 20, 2024 through Nov 20, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Family Paths, Inc.

  • Community/Behavioral Health Agency
  • Oakland, CA
  • NPI 1639389729
  NPD (past)

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

{
    "created_epoch": "1263513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1740511609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 CHALLENGER WAY",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954075441",
            "telephone_number": "707-565-3410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 CHALLENGER WAY",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954075441",
            "telephone_number": "707-565-3410",
            "fax_number": "707-565-6914"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22455 Maple Ct",
            "address_2": "Suite 402",
            "address_purpose": "LOCATION",
            "city": "Hayward",
            "state": "CA",
            "postal_code": "945414020",
            "country_code": "US",
            "telephone_number": "510-582-0148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURRILL",
        "first_name": "PHILLIP",
        "middle_name": "D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-15",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "58914",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "84557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Autumn Burnes, M.D.
• Nathan Burnett, PTA
• Burnside Therapy Solutions, Marriage and Family Therapy, Professional Corporation
• Jaime Rae Burnside, LMFT
• Earl Ronald Burrell, D.D.S.
• Smrity Singh Burritt
• Calla J Burton
• Phalacia Lindell Burton, RN
• Bryan Emerson Bush
• Sunny Bush, NP

• Marriage & Family Therapist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.