Healthcare Provider Details

I. General information

NPI: 1760193411
Provider Name (Legal Business Name): JOSHUA DURR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 MAIN ST
GREAT BEND KS
67530-4007
US

IV. Provider business mailing address

110 W OTIS AVE
SALINA KS
67401-8713
US

V. Phone/Fax

Practice location:
  • Phone: 785-825-0541
  • Fax:
Mailing address:
  • Phone: 785-825-0541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2511
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: