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Individual

DERRICK CHARLES BURCH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
BHRS

Contact information

Practice address
4112 S 130TH EAST AVE APT 714B, TULSA, OK 74134-1110
(918) 938-8712
Mailing address
4112 S 130TH EAST AVE APT 714B, TULSA, OK 74134-1110
(918) 938-8712

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Enumeration date
11/03/2012
Last updated
11/03/2012
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