Provider Demographics
NPI:1073781563
Name:DURRANT, TERESA KELLY
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:KELLY
Last Name:DURRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 AZALEA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1527
Mailing Address - Country:US
Mailing Address - Phone:415-482-6152
Mailing Address - Fax:
Practice Address - Street 1:35 AZALEA AVE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1527
Practice Address - Country:US
Practice Address - Phone:415-482-6152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health