MEDICARE: MR. WILLIAM J. DUFF M.A. LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		AZ
2	101YP2500X	Professional Counselor		AZ

General Provider Information

NPI Number	:	1134351869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM J. DUFF M.A. LAC

Provider Business Mailing Address
First Line	:	5701 W TALAVI BLVD
Second Line	:	SUITE 180
City	:	GLENDALE
State	:	AZ
Zip	:	85306-1886
Country	:	US
Telephone Number	:	623-486-8202
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 W. TALAVI BOULEVARD
Second Line	:	SUITE 180
City	:	PHOENIX
State	:	AZ
Zip	:	85306
Country	:	US
Telephone Number	:	623-486-8202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	10/01/2010

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