Provider Demographics
NPI:1740836543
Name:BURTON, JADERRIUS
Entity type:Individual
Prefix:MR
First Name:JADERRIUS
Middle Name:
Last Name:BURTON
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 1:500 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6532
Mailing Address - Country:US
Mailing Address - Phone:318-450-4911
Mailing Address - Fax:318-855-4396
Practice Address - Street 1:500 N 21ST ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6532
Practice Address - Country:US
Practice Address - Phone:318-450-4911
Practice Address - Fax:318-855-4396
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator