Provider Demographics
NPI:1114371325
Name:DURFEY, MIKAELA (LPC)
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:DURFEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 NORTH COUNTRY CLUB ROAD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1910
Mailing Address - Country:US
Mailing Address - Phone:520-322-6274
Mailing Address - Fax:520-509-4496
Practice Address - Street 1:5240 EAST KNIGHT DRIVE
Practice Address - Street 2:STE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2122
Practice Address - Country:US
Practice Address - Phone:520-209-1919
Practice Address - Fax:520-207-6200
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16957101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ330955Medicaid