Provider Demographics
NPI:1699116822
Name:DURAN, ANTONIO (PHD, MSC-MFCT, QMHP)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:DURAN
Suffix:
Gender:M
Credentials:PHD, MSC-MFCT, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 W 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-1694
Mailing Address - Country:US
Mailing Address - Phone:541-343-9706
Mailing Address - Fax:
Practice Address - Street 1:1720 W 25TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-1694
Practice Address - Country:US
Practice Address - Phone:541-343-9706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YA0400X, 106H00000X
CA75558106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty