Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1994 | KS |
Y | 103TC0700X | Clinical Psychologist | 1994 | KS |
N | 103G00000X | Clinical Psychologist | 6301013423 | MI |
N | 103TC0700X | Clinical Psychologist | 6301013423 | MI |
NPI | 1013160100 |
---|---|
Provider Name | Christine Ann Durrett |
First Address | Manhattan, KS 66502-2853 |
Second Address | Manhattan, KS 66502-2853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2008 |
Last Update Date | 19/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20075005OA | (05) | KS |