Provider Demographics
NPI:1871669440
Name:DURBIN, HARVEY J JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:J
Last Name:DURBIN
Suffix:JR
Gender:M
Credentials:PHD
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 60104
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79711
Mailing Address - Country:US
Mailing Address - Phone:432-550-9208
Mailing Address - Fax:432-550-0139
Practice Address - Street 1:855 CENTRAL
Practice Address - Street 2:SUITE 31B
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761
Practice Address - Country:US
Practice Address - Phone:432-550-9208
Practice Address - Fax:432-550-0139
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21610103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085831801Medicaid
R44802Medicare UPIN
TX085831801Medicaid