Provider Demographics
NPI:1457525008
Name:DUHON, KERMIT WILLIAM (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KERMIT
Middle Name:WILLIAM
Last Name:DUHON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:DUHON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:272 NW MEDICAL LOOP STE E
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-5545
Mailing Address - Country:US
Mailing Address - Phone:541-464-4456
Mailing Address - Fax:
Practice Address - Street 1:2700 NW STEWART PKWY
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1281
Practice Address - Country:US
Practice Address - Phone:541-464-4456
Practice Address - Fax:541-440-3554
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2209-C1041C0700X
ORL4959104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR160755OtherMEDICARE PTAN
AR2209-COtherLCSW LICENSE NUMBER
OR500646713Medicaid