Provider Demographics
NPI:1407190861
Name:DURHAM, VANCE H (LMFT)
Entity type:Individual
Prefix:
First Name:VANCE
Middle Name:H
Last Name:DURHAM
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 NE BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-1909
Mailing Address - Country:US
Mailing Address - Phone:580-353-0222
Mailing Address - Fax:
Practice Address - Street 1:3101 NE BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-1909
Practice Address - Country:US
Practice Address - Phone:580-353-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-24
Last Update Date:2012-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLMFT # 792106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist