Provider Demographics
NPI:1184419160
Name:DONLEY BURGE, CRYSTAL MARIE (CADC R)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARIE
Last Name:DONLEY BURGE
Suffix:
Gender:F
Credentials:CADC R
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:MARIE
Other - Last Name:BURGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EMT BASIC
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:JORDAN VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97910-0184
Mailing Address - Country:US
Mailing Address - Phone:775-232-9325
Mailing Address - Fax:541-586-3096
Practice Address - Street 1:810 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:JORDAN VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97910-9516
Practice Address - Country:US
Practice Address - Phone:775-232-9325
Practice Address - Fax:541-586-3096
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-24-4758101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)