Provider Demographics
NPI:1053394650
Name:DUNN, JAN M (PHD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:M
Last Name:DUNN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:ELAINE
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:8222 DOUGLAS AVE
Mailing Address - Street 2:#777
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5923
Mailing Address - Country:US
Mailing Address - Phone:214-890-6637
Mailing Address - Fax:214-276-1380
Practice Address - Street 1:8222 DOUGLAS AVE
Practice Address - Street 2:#777
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5923
Practice Address - Country:US
Practice Address - Phone:214-890-6637
Practice Address - Fax:214-276-1380
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12149101YM0800X, 101YP2500X
TX4750106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026169501Medicaid