Provider Demographics
NPI:1215493325
Name:DURAN, JUAN GUTIERREZ (MS AMFT)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:GUTIERREZ
Last Name:DURAN
Suffix:
Gender:M
Credentials:MS AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11731 TELEGRAPH RD STE K
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-6815
Mailing Address - Country:US
Mailing Address - Phone:562-907-7429
Mailing Address - Fax:
Practice Address - Street 1:11731 TELEGRAPH RD STE K
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-6815
Practice Address - Country:US
Practice Address - Phone:562-907-7429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT146570106H00000X
CA106H00000X
CAAMFT110691106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist