Provider Demographics
NPI:1528348554
Name:DURHAM, LOURDES
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13300 OLD BLANCO RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7738
Mailing Address - Country:US
Mailing Address - Phone:210-896-6726
Mailing Address - Fax:210-468-8243
Practice Address - Street 1:13300 OLD BLANCO RD
Practice Address - Street 2:SUITE 145
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7738
Practice Address - Country:US
Practice Address - Phone:210-896-6726
Practice Address - Fax:210-468-8243
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66064101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional