Provider Demographics
NPI:1770997769
Name:DURROUGH, JAMES (BA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DURROUGH
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1009 CLAY RIDGE RD
Mailing Address - Street 2:717 EL CABO REY
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1410
Mailing Address - Country:US
Mailing Address - Phone:702-418-7217
Mailing Address - Fax:
Practice Address - Street 1:717 EL CABO REY AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-3143
Practice Address - Country:US
Practice Address - Phone:702-418-7217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation