Provider Demographics
NPI:1770348229
Name:DUONG, ANTHONY (EDS)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:DUONG
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 E TACHEVAH DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4903
Mailing Address - Country:US
Mailing Address - Phone:760-416-8190
Mailing Address - Fax:
Practice Address - Street 1:777 E TACHEVAH DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4903
Practice Address - Country:US
Practice Address - Phone:760-416-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200074762103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool