Provider Demographics
NPI:1265671747
Name:DURHAM, ANNA MARIE (MS, MFT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:DURHAM
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, MFT
Mailing Address - Street 1:1249 OAK VIEW LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-1527
Mailing Address - Country:US
Mailing Address - Phone:909-596-0043
Mailing Address - Fax:909-593-9491
Practice Address - Street 1:1249 OAK VIEW LN
Practice Address - Street 2:SUITE 100
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-1527
Practice Address - Country:US
Practice Address - Phone:909-596-0043
Practice Address - Fax:909-593-9491
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32825106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT328250OtherANTHEM BLUE CROSS