Provider Demographics
NPI:1518043900
Name:DOLLIVER, DUANE T (MS)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:T
Last Name:DOLLIVER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 S 40TH AVE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3806
Mailing Address - Country:US
Mailing Address - Phone:509-966-7246
Mailing Address - Fax:509-966-5731
Practice Address - Street 1:1015 S 40TH AVE
Practice Address - Street 2:SUITE 23
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3806
Practice Address - Country:US
Practice Address - Phone:509-966-7246
Practice Address - Fax:509-966-5731
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004732101YM0800X
WALF00001518106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist