Healthcare Provider Details

I. General information

NPI: 1669667085
Provider Name (Legal Business Name): STEVE EDGAR BURDEX BS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 10/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 EAST ALMAR AVE.
CHICKASHA OK
73023-0829
US

IV. Provider business mailing address

198 EAST ALMAR AVE.
CHICKASHA OK
73023-0829
US

V. Phone/Fax

Practice location:
  • Phone: 405-222-5437
  • Fax: 405-222-5441
Mailing address:
  • Phone: 405-222-5437
  • Fax: 405-222-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: