Provider Demographics
NPI:1336595396
Name:DURDA, TONI
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:DURDA
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 1:17505 N 79TH AVE STE 302D
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8729
Mailing Address - Country:US
Mailing Address - Phone:602-842-4625
Mailing Address - Fax:888-807-0441
Practice Address - Street 1:17505 N 79TH AVE STE 302D
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8729
Practice Address - Country:US
Practice Address - Phone:602-842-4625
Practice Address - Fax:888-807-0441
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-15638101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health