Provider Demographics
NPI:1245633908
Name:MARVELLY, DUKEN (LCSW, LCDC)
Entity type:Individual
Prefix:
First Name:DUKEN
Middle Name:
Last Name:MARVELLY
Suffix:
Gender:M
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10505 TOWN AND COUNTRY WAY
Mailing Address - Street 2:P.O BOX 19821
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77224
Mailing Address - Country:US
Mailing Address - Phone:832-774-1444
Mailing Address - Fax:
Practice Address - Street 1:3724 FM 1960 RD W
Practice Address - Street 2:300M
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3528
Practice Address - Country:US
Practice Address - Phone:832-774-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12891101YA0400X
TX56903104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141987279Medicaid
TX141987279Medicaid
TX141987279Medicare PIN