Provider Demographics
NPI:1568796951
Name:DURAN, GABE MICHAEL (LPC)
Entity Type:Individual
Prefix:
First Name:GABE
Middle Name:MICHAEL
Last Name:DURAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 KNIGHTSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-2467
Mailing Address - Country:US
Mailing Address - Phone:907-978-1009
Mailing Address - Fax:
Practice Address - Street 1:640 KNIGHTSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-2467
Practice Address - Country:US
Practice Address - Phone:907-978-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1871624536OtherNPI
AKMH2770Medicaid