Provider Demographics
NPI:1134351869
Name:DUFF, WILLIAM J (MA LAC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:DUFF
Suffix:
Gender:M
Credentials:MA LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 W TALAVI BLVD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-1886
Mailing Address - Country:US
Mailing Address - Phone:623-486-8202
Mailing Address - Fax:
Practice Address - Street 1:5701 W. TALAVI BOULEVARD
Practice Address - Street 2:SUITE 180
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:623-486-8202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health