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General NPI Number Information
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NPI Number | 1114431186
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Entity Type | Individual
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Provider Name | MEG DUFOUR MA, LAC
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Gender | Female
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 18275 N 59TH AVE STE K-164
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City | GLENDALE
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State | AZ
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Zip | 85308-1260
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Country | US
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Telephone | 413-329-4831
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Fax |
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Provider Business Mailing Address
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Address Line | 30892 N 118TH LN
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City | PEORIA
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State | AZ
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Zip | 85383-8205
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LAC15586
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License Number State | AZ
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