Provider Demographics
NPI:1952456451
Name:DUCLOS, MARCEL AIME (LCMHC, LPC, LISAC)
Entity Type:Individual
Prefix:
First Name:MARCEL
Middle Name:AIME
Last Name:DUCLOS
Suffix:
Gender:M
Credentials:LCMHC, LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 SW RAMSEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5500
Mailing Address - Country:US
Mailing Address - Phone:541-956-4943
Mailing Address - Fax:541-956-5463
Practice Address - Street 1:715 SW RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5500
Practice Address - Country:US
Practice Address - Phone:541-956-4943
Practice Address - Fax:541-956-5463
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH542101YM0800X
AZLISAC-15024101YA0400X
AZLPC-15029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH14Y004897NH02OtherANTHEM BCBS
NH114882OtherTEAMSTERS BEHAVIORAL