Healthcare Provider Details

I. General information

NPI: 1306934104
Provider Name (Legal Business Name): JEFFERY A. BURROWS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7027 MONTGOMERY BLVD NE STE F
ALBUQUERQUE NM
87109-1589
US

IV. Provider business mailing address

7027 MONTGOMERY BLVD NE STE F
ALBUQUERQUE NM
87109-1589
US

V. Phone/Fax

Practice location:
  • Phone: 505-880-0100
  • Fax: 505-880-0102
Mailing address:
  • Phone: 505-880-0100
  • Fax: 505-880-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY ALFRED BURROWS
Title or Position: DIRECTOR
Credential:
Phone: 505-880-0100