Individual
JASON JON BURRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LISAC
Contact information
Practice address
3505 WESTERN AVE, KINGMAN, AZ 86409-3071
(928) 757-8111
Mailing address
552 RAMAR RD, BULLHEAD CITY, AZ 86442-6215
(928) 266-9024
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-6894T
AZ
Other
Enumeration date
04/23/2021
Last updated
07/02/2024
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