Individual
MR. DIEAGO ELLIS BURRESS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5784 FISHER DR APT B, HUBER HEIGHTS, OH 45424-5576
(937) 312-5494
Mailing address
5784 FISHER DR APT B, HUBER HEIGHTS, OH 45424-5576
(937) 312-5494
Taxonomy
Speciality
Code
Description
License number
State
101200000X
Drama Therapist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Enumeration date
08/25/2023
Last updated
08/25/2023
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