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1104471390
TYSON J BURRUSS
MEDFORD, OR
NPI
1104471390
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Former Name
TYSON J GOOD-KIMBROUGH
Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
(Licence: OR 9621038)
Enumeration Date
2019-08-05
Last Update Date
2019-08-05
Business Address
TYSON J BURRUSS
3709 CITATION WAY STE 102
MEDFORD, OR 97504-9022
Phone number: 541-500-6532
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Mailing Address
TYSON J BURRUSS
21600 OXNARD ST STE 1800
WOODLAND HILLS, CA 91367-7807
Phone number: 818-345-2345
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