Provider Demographics
NPI:1538343181
Name:DURHAM, MARK HUTCHISON (LCSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:HUTCHISON
Last Name:DURHAM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 HARMON DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75602-3041
Mailing Address - Country:US
Mailing Address - Phone:903-353-5373
Mailing Address - Fax:903-295-6705
Practice Address - Street 1:606 HARMON DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75602-3041
Practice Address - Country:US
Practice Address - Phone:903-353-5373
Practice Address - Fax:903-295-6705
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical