Provider Demographics
NPI:1164564365
Name:DUKE, MISTY CHRISTINA (MA)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:CHRISTINA
Last Name:DUKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 THUNDERBIRD DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3832
Mailing Address - Country:US
Mailing Address - Phone:915-845-3122
Mailing Address - Fax:915-845-4165
Practice Address - Street 1:300 THUNDERBIRD DR
Practice Address - Street 2:SUITE 12
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3832
Practice Address - Country:US
Practice Address - Phone:915-845-3122
Practice Address - Fax:915-845-4165
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15867101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional