Provider Demographics
NPI:1306934104
Name:JEFFERY A. BURROWS
Entity type:Organization
Organization Name:JEFFERY A. BURROWS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:BURROWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-880-0100
Mailing Address - Street 1:7027 MONTGOMERY BLVD NE
Mailing Address - Street 2:STE F
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1589
Mailing Address - Country:US
Mailing Address - Phone:505-880-0100
Mailing Address - Fax:505-880-0102
Practice Address - Street 1:7027 MONTGOMERY BLVD NE
Practice Address - Street 2:STE F
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1589
Practice Address - Country:US
Practice Address - Phone:505-880-0100
Practice Address - Fax:505-880-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty