Provider Demographics
NPI:1972629202
Name:ANGLIN, DUANE (MC)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:
Last Name:ANGLIN
Suffix:
Gender:M
Credentials:MC
Other - Prefix:
Other - First Name:WAYNE
Other - Middle Name:
Other - Last Name:ANGLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MC
Mailing Address - Street 1:836 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3834
Mailing Address - Country:US
Mailing Address - Phone:360-501-4122
Mailing Address - Fax:360-501-4122
Practice Address - Street 1:836 MAPLE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3834
Practice Address - Country:US
Practice Address - Phone:360-501-4122
Practice Address - Fax:360-501-4122
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005235101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health