Jacque Burger, LDAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Fallon, NV
NPI 1780091231 · NPPES record last updated Jul 17, 2014
Key facts
- NPI
- 1780091231
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 01472-L (NV)
- Practice address
- 1490 Grimes St
Fallon, NV 89406-3103 - Phone
- (775) 423-1412
- NPI assigned
- Jul 16, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01472-L | NV | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Churchill Council on Alcohol & Other Drugs | Past |
Accepting new patients | |
| Churchill Council on Alcohol & Other Drugs | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 01472-L | NV | Yes |
Addresses
Primary practice location
1490 Grimes St
Fallon, NV 89406-3103
Mailing address
PO Box 1240
Fallon, NV 89407-1240
Phone (775) 423-1412
Other providers in Fallon, NV
- Alyssa Renee Brooks
- Joann Brooks
- Katherine Brown
- Terry T Brown
- Paul Burch
- Kylie Burgess
- Timothy F Burke
- Steven Thomas Calderwood
- Nancy M Campbell
- Jared Carlton
All providers in Fallon, NV · Addiction (Substance Use Disorder) Counselor in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.