Healthcare Provider Details

I. General information

NPI: 1528282571
Provider Name (Legal Business Name): SAMMY R DURAN LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 MENAUL BLVD NE STE E
ALBUQUERQUE NM
87110-2861
US

IV. Provider business mailing address

3600 MENAUL BLVD NE STE E
ALBUQUERQUE NM
87110-2861
US

V. Phone/Fax

Practice location:
  • Phone: 505-323-3785
  • Fax: 505-323-3850
Mailing address:
  • Phone: 505-323-3785
  • Fax: 505-323-3850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0100141
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: