Individual
MR. JASON MICHAEL BURDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CCDC, CBHCM, BHRS
Contact information
Practice address
23 E ROSS AVE, SAPULPA, OK 74066-6423
(918) 640-0290
(918) 227-1125
Mailing address
1006 N LINCOLN AVE, SAND SPRINGS, OK 74063-7823
(918) 490-2270
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
101YP2500X
OK
Other
Enumeration date
11/16/2010
Last updated
11/16/2010
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