MEDICARE: BYRON ANTHONY DURAND JR. BS, CAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1374	LA

General Provider Information

NPI Number	:	1609127992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BYRON ANTHONY DURAND JR. BS, CAC

Provider Business Mailing Address
First Line	:	2251 LEON C SIMON DR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-4323
Country	:	US
Telephone Number	:	504-344-2935
Fax Number	:

Provider Business Practice Location Address
First Line	:	2251 LEON C SIMON DR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-4323
Country	:	US
Telephone Number	:	504-344-2935
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2012
Last Update Date	:	09/26/2012

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