Provider Demographics
NPI:1609623289
Name:DURHAM, MACY ELIZABETH (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:ELIZABETH
Last Name:DURHAM
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 KAYS CT
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-7661
Mailing Address - Country:US
Mailing Address - Phone:817-688-9949
Mailing Address - Fax:
Practice Address - Street 1:1111 AUSTIN HWY APT 3216
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4895
Practice Address - Country:US
Practice Address - Phone:817-688-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional