Provider Demographics
NPI:1205499894
Name:DUREN, RACHEL MICHELLE
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MICHELLE
Last Name:DUREN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:MICHELLE
Other - Last Name:DUREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2421 WASHBURN WAY STE K
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4531
Mailing Address - Country:US
Mailing Address - Phone:541-885-1675
Mailing Address - Fax:
Practice Address - Street 1:2421 WASHBURN WAY STE K
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4531
Practice Address - Country:US
Practice Address - Phone:541-885-1675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORIN-10196058106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician