Healthcare Provider Details

I. General information

NPI: 1134525447
Provider Name (Legal Business Name): JOHN BURR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S OREM BLVD
OREM UT
84058-5011
US

IV. Provider business mailing address

901 S OREM BLVD
OREM UT
84058-5011
US

V. Phone/Fax

Practice location:
  • Phone: 801-225-7805
  • Fax:
Mailing address:
  • Phone: 801-225-7805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number003825867
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOHN BURR
Title or Position: PRESIDENT
Credential: LCSW
Phone: 801-225-7805