Healthcare Provider Details

I. General information

NPI: 1154700896
Provider Name (Legal Business Name): BURROUGHS & JONES COUNSELING AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 DAWSON RD STE 110
ALBANY GA
31707-3800
US

IV. Provider business mailing address

PO BOX 2036
TIFTON GA
31793-2036
US

V. Phone/Fax

Practice location:
  • Phone: 229-392-4457
  • Fax: 229-382-8353
Mailing address:
  • Phone: 480-748-9534
  • Fax: 229-382-8353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC008251
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLPC008251
License Number StateGA

VIII. Authorized Official

Name: JAMES E BURROUGHS
Title or Position: CEO
Credential: MBA
Phone: 229-392-4457