Provider Demographics
NPI:1013616713
Name:DUREN, ALTHEA
Entity Type:Individual
Prefix:DR
First Name:ALTHEA
Middle Name:
Last Name:DUREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8380 LAGOS DE CAMPO BLVD APT 201
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-8512
Mailing Address - Country:US
Mailing Address - Phone:786-553-8955
Mailing Address - Fax:
Practice Address - Street 1:8380 LAGOS DE CAMPO BLVD APT 201
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-8512
Practice Address - Country:US
Practice Address - Phone:786-553-8955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL690339101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690339OtherFLORIDA DEPARTMENT OF EDUCATION CERTIFICATE