Provider Demographics
NPI:1629311667
Name:DUNCAN, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 E COLLEGE AVE
Mailing Address - Street 2:APT B7
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-4504
Mailing Address - Country:US
Mailing Address - Phone:913-744-0067
Mailing Address - Fax:
Practice Address - Street 1:1809 E COLLEGE AVE
Practice Address - Street 2:APT B7
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-4504
Practice Address - Country:US
Practice Address - Phone:913-744-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst