Provider Demographics
NPI:1235855057
Name:BURSMA, GERRIT (ASUDC)
Entity Type:Individual
Prefix:
First Name:GERRIT
Middle Name:
Last Name:BURSMA
Suffix:
Gender:M
Credentials:ASUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8199 S ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-7528
Mailing Address - Country:US
Mailing Address - Phone:616-477-4494
Mailing Address - Fax:
Practice Address - Street 1:8199 S ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-7528
Practice Address - Country:US
Practice Address - Phone:616-477-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)