Provider Demographics
NPI:1235846593
Name:DUPERRON, DENISE VANESSA (MFTA)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:VANESSA
Last Name:DUPERRON
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29382
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98228-1382
Mailing Address - Country:US
Mailing Address - Phone:310-634-2903
Mailing Address - Fax:
Practice Address - Street 1:4350 CORDATA PKWY STE 102
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8278
Practice Address - Country:US
Practice Address - Phone:360-922-6977
Practice Address - Fax:360-922-3737
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61253381106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist