Healthcare Provider Details

I. General information

NPI: 1770997769
Provider Name (Legal Business Name): JAMES DURROUGH BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 EL CABO REY AVE
NORTH LAS VEGAS NV
89081-3143
US

IV. Provider business mailing address

1009 CLAY RIDGE RD 717 EL CABO REY
NORTH LAS VEGAS NV
89031-1410
US

V. Phone/Fax

Practice location:
  • Phone: 702-418-7217
  • Fax:
Mailing address:
  • Phone: 702-418-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: