Provider Demographics
NPI:1902550221
Name:DURAN, MADISON LEE (LAC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:LEE
Last Name:DURAN
Suffix:
Gender:F
Credentials:LAC
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 1254
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1254
Mailing Address - Country:US
Mailing Address - Phone:870-497-2650
Mailing Address - Fax:870-277-4060
Practice Address - Street 1:9101 N RODNEY PARHAM RD STE B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1685
Practice Address - Country:US
Practice Address - Phone:501-389-8100
Practice Address - Fax:888-977-2956
Is Sole Proprietor?:No
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2201015101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional