Provider Demographics
NPI:1932756038
Name:BURGER, MYRON JON (LSAA, LADAC)
Entity Type:Individual
Prefix:MR
First Name:MYRON
Middle Name:JON
Last Name:BURGER
Suffix:
Gender:M
Credentials:LSAA, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 CERRILLOS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3521
Mailing Address - Country:US
Mailing Address - Phone:602-565-1656
Mailing Address - Fax:505-212-0576
Practice Address - Street 1:1501 CERRILLOS RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3521
Practice Address - Country:US
Practice Address - Phone:602-565-1656
Practice Address - Fax:505-212-0576
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCAD0218661101YA0400X
NM0151611101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)