Basic Information
| Provider Information | |||||||||
| NPI: | 1447408240 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUKE | ||||||||
| FirstName: | AUDRA | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5 | ||||||||
| Address2: | |||||||||
| City: | RIDGWAY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814320005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 5540339318 | ||||||||
| Practice Location | |||||||||
| Address1: | 640 SHERMAN ST., UNIT H | ||||||||
| Address2: | |||||||||
| City: | RIDGWAY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703180529 | ||||||||
| FaxNumber: | 8554033931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2008 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 68800096 | 05 | CO | MEDICAID |