Fred Joseph Durham
Psychologist, Cognitive & Behavioral in Taylor, MI. Individual provider (NPI-1).
NPI number1003631433
StatusActive
Last updated in NPPESNov 20, 2024
Details
- NPI
- 1003631433
- Entity type
- Individual (NPI-1)
- Name
- Fred Joseph Durham
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 20, 2024
- Certification date
- Nov 20, 2024
- Last updated
- Nov 20, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TB0200X | Psychologist, Cognitive & Behavioral | 6851118945 | MI | Yes |
Practice location
26650 Eureka Rd Ste ATaylor, MI 48180-4835
Phone 313-561-5100
Mailing address
50216 Paine StCanton, MI 48188-3332
Phone 765-431-0547
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