Provider Demographics
NPI:1942350640
Name:DURRANCE, MICHELE L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:L
Last Name:DURRANCE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12814 CASTLEMAINE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4468
Mailing Address - Country:US
Mailing Address - Phone:813-814-1818
Mailing Address - Fax:
Practice Address - Street 1:13907 N DALE MABRY HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2411
Practice Address - Country:US
Practice Address - Phone:813-961-7727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6956103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical