Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 0004816 | CO |
NPI | 1063746931 |
---|---|
Provider Name | Dr. Darnell Autry Durrah JR. |
First Address | Fort Sam Houston, TX 78234-7508 |
Second Address | Fort Wainwright, AK 99703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2009 |
Last Update Date | 18/06/2018 |