Provider Demographics
NPI:1437770013
Name:DUARTE, ELSA M (LPC)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:M
Last Name:DUARTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ELSA
Other - Middle Name:
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-3353
Mailing Address - Country:US
Mailing Address - Phone:520-838-5600
Mailing Address - Fax:
Practice Address - Street 1:1900 W SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2215
Practice Address - Country:US
Practice Address - Phone:520-838-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD00162223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional