MEDICARE: GINA DUNCKEL PSYD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1518374982	OTHER		NPI INDIVIDUAL

General Provider Information

NPI Number	:	1780248989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GINA DUNCKEL PSYD PLLC

Provider Business Mailing Address
First Line	:	PO BOX 303
Second Line	:
City	:	KEMAH
State	:	TX
Zip	:	77565-0303
Country	:	US
Telephone Number	:	281-910-3913
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 MARINA BAY DR BLDG 113E
Second Line	:
City	:	CLEAR LAKE SHORES
State	:	TX
Zip	:	77565-2263
Country	:	US
Telephone Number	:	281-910-3303
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. GINA N DUNCKEL SMITH
Credential	:	PSYD
Telephone Number	:	281-910-3313

Provider Enumeration Date	:	04/24/2019
Last Update Date	:	06/22/2023

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