Provider Demographics
NPI:1902631021
Name:DUREUS, ELONIE ESTHER (LCPAA AND LCCA)
Entity type:Individual
Prefix:
First Name:ELONIE
Middle Name:ESTHER
Last Name:DUREUS
Suffix:
Gender:F
Credentials:LCPAA AND LCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 HORTON DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1328
Mailing Address - Country:US
Mailing Address - Phone:214-236-8160
Mailing Address - Fax:
Practice Address - Street 1:1408 HORTON DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1328
Practice Address - Country:US
Practice Address - Phone:214-236-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD14960253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency