Provider Demographics
NPI:1063604361
Name:DUKE, GARY MARK (LPC)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:MARK
Last Name:DUKE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1016
Mailing Address - Street 2:
Mailing Address - City:NOEL
Mailing Address - State:MO
Mailing Address - Zip Code:64854-1016
Mailing Address - Country:US
Mailing Address - Phone:417-592-9068
Mailing Address - Fax:
Practice Address - Street 1:115 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GOODMAN
Practice Address - State:MO
Practice Address - Zip Code:64843-9784
Practice Address - Country:US
Practice Address - Phone:417-592-9068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005028618101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional