Provider Demographics
NPI:1639795511
Name:DUREY, MINDY LYNNE (LAC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:LYNNE
Last Name:DUREY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 TIMBERWOLF TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4965
Mailing Address - Country:US
Mailing Address - Phone:870-866-6616
Mailing Address - Fax:
Practice Address - Street 1:7 MEDICAL LN STE H
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4918
Practice Address - Country:US
Practice Address - Phone:501-428-0935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2006079101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health