Individual
MRS. CHARLOTTE JEAN BURROUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
16050 COUNTY ROAD 1565, ADA, OK 74820-7911
(580) 436-9099
(580) 436-9146
Mailing address
PO BOX 126, FITTSTOWN, OK 74842-0126
(580) 436-9099
(580) 436-9146
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1805
OK
Other
Enumeration date
10/05/2005
Last updated
07/08/2007
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