Individual
JAELEN BURROUGHS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2695 DAVE WARD DR APT G6, CONWAY, AR 72034-6783
(205) 603-0334
Mailing address
2695 DAVE WARD DR APT G6, CONWAY, AR 72034-6783
(205) 603-0334
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
AR
Other
Enumeration date
05/12/2022
Last updated
05/12/2022
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