Provider Demographics
NPI:1801388335
Name:DURAN, MARISELA (MED, LMHC)
Entity Type:Individual
Prefix:
First Name:MARISELA
Middle Name:
Last Name:DURAN
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3440
Mailing Address - Country:US
Mailing Address - Phone:575-526-9878
Mailing Address - Fax:575-526-7835
Practice Address - Street 1:530 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3440
Practice Address - Country:US
Practice Address - Phone:575-526-9878
Practice Address - Fax:575-526-7835
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0196481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM79139035Medicaid