Provider Demographics
NPI:1134390677
Name:DURAK, DENISE G (PSYD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:G
Last Name:DURAK
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 1:7889 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-9999
Mailing Address - Country:US
Mailing Address - Phone:269-465-4000
Mailing Address - Fax:269-465-4001
Practice Address - Street 1:7889 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9999
Practice Address - Country:US
Practice Address - Phone:269-465-4000
Practice Address - Fax:269-465-4001
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003189103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist