Provider Demographics
NPI:1619268935
Name:DURST, DUANE ALLEN (MFT)
Entity Type:Individual
Prefix:MR
First Name:DUANE
Middle Name:ALLEN
Last Name:DURST
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23282 MILL CREEK DR
Mailing Address - Street 2:SUITE 100E
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1658
Mailing Address - Country:US
Mailing Address - Phone:949-533-2292
Mailing Address - Fax:714-200-0571
Practice Address - Street 1:23282 MILL CREEK DR
Practice Address - Street 2:SUITE 100E
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1658
Practice Address - Country:US
Practice Address - Phone:949-533-2292
Practice Address - Fax:714-200-0571
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35453101YA0400X, 106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health