Provider Demographics
NPI:1689201477
Name:BURROUGHS, IRWIN (MHT ABNLP CTAA CISM)
Entity Type:Individual
Prefix:
First Name:IRWIN
Middle Name:
Last Name:BURROUGHS
Suffix:
Gender:M
Credentials:MHT ABNLP CTAA CISM
Other - Prefix:
Other - First Name:IRWIN
Other - Middle Name:
Other - Last Name:BURROUGHS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHT ABNLP CTAA CISM
Mailing Address - Street 1:8085 CA-26 SUITE 2A
Mailing Address - Street 2:
Mailing Address - City:MOKELUMNE HL
Mailing Address - State:CA
Mailing Address - Zip Code:95245
Mailing Address - Country:US
Mailing Address - Phone:209-283-3336
Mailing Address - Fax:
Practice Address - Street 1:8085 CA-26 SUITE 2A
Practice Address - Street 2:
Practice Address - City:MOKELUMNE HL
Practice Address - State:CA
Practice Address - Zip Code:95245
Practice Address - Country:US
Practice Address - Phone:209-283-3336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty