Healthcare Provider Details

I. General information

NPI: 1356776538
Provider Name (Legal Business Name): ANDRES MIGUEL DURAN LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 JEFFERSON ST NE STE 300
ALBUQUERQUE NM
87109-4314
US

IV. Provider business mailing address

6908 ASTAIR AVE NW
ALBUQUERQUE NM
87120-4422
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-1114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0183121
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: