Provider Demographics
NPI:1437322096
Name:DURIS, MARK CHARLES (PHD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHARLES
Last Name:DURIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 REID ST # A
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1101
Mailing Address - Country:US
Mailing Address - Phone:253-968-3162
Mailing Address - Fax:253-968-3278
Practice Address - Street 1:9040 REID ST # A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1101
Practice Address - Country:US
Practice Address - Phone:253-968-3162
Practice Address - Fax:253-968-3278
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003723103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical