Provider Demographics
NPI:1932300175
Name:DUFFY, JACK (MA PSYCHOLOGY)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:
Last Name:DUFFY
Suffix:
Gender:M
Credentials:MA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 11TH ST STE 200B
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7064
Mailing Address - Country:US
Mailing Address - Phone:360-733-5818
Mailing Address - Fax:360-715-3657
Practice Address - Street 1:1201 11TH ST STE 200B
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7064
Practice Address - Country:US
Practice Address - Phone:360-733-5818
Practice Address - Fax:360-715-3657
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003795101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health