Provider Demographics
NPI:1659257913
Name:DUQUE, GISELLE
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:DUQUE
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 1:111 PIPES DR APT 305
Mailing Address - Street 2:
Mailing Address - City:DILLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78017-3741
Mailing Address - Country:US
Mailing Address - Phone:305-803-6276
Mailing Address - Fax:
Practice Address - Street 1:111 PIPES DR
Practice Address - Street 2:APARTAMENT 305
Practice Address - City:DILLEY
Practice Address - State:TX
Practice Address - Zip Code:78017
Practice Address - Country:US
Practice Address - Phone:305-803-6276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51363084106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician