MEDICARE: MS. MAUREEN TERESA DURKEE A.T.R., M.F.T.

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	106H00000X	Marriage & Family Therapist	MFC22666	CA

General Provider Information

NPI Number	:	1356551584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAUREEN TERESA DURKEE A.T.R., M.F.T.

Provider Business Mailing Address
First Line	:	PO BOX 442
Second Line	:
City	:	SANTA YSABEL
State	:	CA
Zip	:	92070-0442
Country	:	US
Telephone Number	:	760-765-0134
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S IMPERIAL AVE
Second Line	:	SUITE NUMBER 6
City	:	EL CENTRO
State	:	CA
Zip	:	92243-3149
Country	:	US
Telephone Number	:	760-765-0134
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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