Provider Demographics
NPI:1891860391
Name:DUELL, DOUGLAS (MFT)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:DUELL
Suffix:
Gender:M
Credentials:MFT
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 1296
Mailing Address - Street 2:
Mailing Address - City:GUERNEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95446-1296
Mailing Address - Country:US
Mailing Address - Phone:707-829-3336
Mailing Address - Fax:707-869-2751
Practice Address - Street 1:3559 ROUND BARN BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1763
Practice Address - Country:US
Practice Address - Phone:707-571-3947
Practice Address - Fax:707-571-3298
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35746106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist