Provider Demographics
NPI:1356058135
Name:SERRANO, DUANE E (CO61200074)
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:E
Last Name:SERRANO
Suffix:
Gender:M
Credentials:CO61200074
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16919 6TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-7815
Mailing Address - Country:US
Mailing Address - Phone:253-579-7486
Mailing Address - Fax:
Practice Address - Street 1:2156 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3004
Practice Address - Country:US
Practice Address - Phone:253-200-0505
Practice Address - Fax:253-200-0636
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61200074101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)