Provider Demographics
NPI:1790836427
Name:DUVAL, DAN R (MA LCMHC)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:R
Last Name:DUVAL
Suffix:
Gender:M
Credentials:MA LCMHC
Other - Prefix:MR
Other - First Name:DAN
Other - Middle Name:R
Other - Last Name:DUVAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LCMHC
Mailing Address - Street 1:7806 51ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-3812
Mailing Address - Country:US
Mailing Address - Phone:802-730-3921
Mailing Address - Fax:
Practice Address - Street 1:7806 51ST AVE NE UNIT B
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3812
Practice Address - Country:US
Practice Address - Phone:802-730-3921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000280101YM0800X
WALH60665969101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007311Medicaid