Provider Demographics
NPI:1134339237
Name:DURHAM, DONALD RALPH (PHD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:RALPH
Last Name:DURHAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 W PEORIA AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4614
Mailing Address - Country:US
Mailing Address - Phone:602-692-9238
Mailing Address - Fax:602-795-7345
Practice Address - Street 1:3233 W PEORIA AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4614
Practice Address - Country:US
Practice Address - Phone:602-692-9238
Practice Address - Fax:602-795-7345
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1822103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ138344Medicare PIN