Healthcare Provider Details

I. General information

NPI: 1689797078
Provider Name (Legal Business Name): JOHN MICHAEL BURR LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

889 S OREM BLVD
OREM UT
84058-5009
US

IV. Provider business mailing address

889 SOUTH OREM BLVD.
OREM UT
84058-5009
US

V. Phone/Fax

Practice location:
  • Phone: 801-225-7805
  • Fax: 801-225-4946
Mailing address:
  • Phone: 801-225-7805
  • Fax: 801-225-4946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number135605-3501
License Number StateUT

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: