Provider Demographics
NPI:1457023657
Name:DURAN, EVELYN (LCDC-I)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:DURAN
Suffix:
Gender:F
Credentials:LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W WHITE ST
Mailing Address - Street 2:
Mailing Address - City:DILLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78017-3815
Mailing Address - Country:US
Mailing Address - Phone:361-208-3109
Mailing Address - Fax:
Practice Address - Street 1:2250 N VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4160
Practice Address - Country:US
Practice Address - Phone:830-757-0117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55638101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)