Provider Demographics
NPI:1336590579
Name:BURR, GREG
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:BURR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 N COVE SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-4347
Mailing Address - Country:US
Mailing Address - Phone:801-867-7909
Mailing Address - Fax:
Practice Address - Street 1:1950 N COVE SPRINGS WAY
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-4347
Practice Address - Country:US
Practice Address - Phone:801-867-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker