MEDICARE: THERESE DUNCAN

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	A3210008	CA

General Provider Information

NPI Number	:	1710350160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESE DUNCAN

Provider Business Mailing Address
First Line	:	21 CALLE VISTA DEL MONTE
Second Line	:
City	:	OAK VIEW
State	:	CA
Zip	:	93022-9507
Country	:	US
Telephone Number	:	805-406-9585
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 CALLE VISTA DEL MONTE
Second Line	:
City	:	OAK VIEW
State	:	CA
Zip	:	93022-9507
Country	:	US
Telephone Number	:	805-406-9585
Fax Number	:

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

Provider Enumeration Date	:	11/06/2015
Last Update Date	:	11/06/2015

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Directions to “ THERESE DUNCAN ” Practice Location

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