Provider Demographics
NPI:1679772941
Name:DUFFY-RANDALL, ANN TERESA (ARNP,DMIN, MA,MSN,BC)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:TERESA
Last Name:DUFFY-RANDALL
Suffix:
Gender:F
Credentials:ARNP,DMIN, MA,MSN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8607 WURZBACH RD BLDG P
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1281
Mailing Address - Country:US
Mailing Address - Phone:210-317-1691
Mailing Address - Fax:
Practice Address - Street 1:8607 WURZBACH RD BLDG P
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1281
Practice Address - Country:US
Practice Address - Phone:210-317-1691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX520687101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health