Healthcare Provider Details

I. General information

NPI: 1972928190
Provider Name (Legal Business Name): ASHLEY DUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 E FOUNTAIN ST
LONG BEACH CA
90804-3023
US

IV. Provider business mailing address

4151 E FOUNTAIN ST
LONG BEACH CA
90804-3023
US

V. Phone/Fax

Practice location:
  • Phone: 562-719-9250
  • Fax: 562-344-3794
Mailing address:
  • Phone: 562-719-9250
  • Fax: 562-344-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number75702
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: