Healthcare Provider Details

I. General information

NPI: 1134246341
Provider Name (Legal Business Name): DUANE DUKLES LPCC-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 ROCKSIDE WOODS BLVD N STE 305
INDEPENDENCE OH
44131-2343
US

IV. Provider business mailing address

6999 FRY RD
CLEVELAND OH
44130-2512
US

V. Phone/Fax

Practice location:
  • Phone: 216-525-1885
  • Fax:
Mailing address:
  • Phone: 440-781-2690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE-0008251
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: