Provider Demographics
NPI:1649415118
Name:HANKS, DUAN EDWARD (LCDC)
Entity Type:Individual
Prefix:MR
First Name:DUAN
Middle Name:EDWARD
Last Name:HANKS
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:WALLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77485-0698
Mailing Address - Country:US
Mailing Address - Phone:979-478-6117
Mailing Address - Fax:
Practice Address - Street 1:4610 WESTERDALE DR
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-4223
Practice Address - Country:US
Practice Address - Phone:979-478-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3553101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)