Healthcare Provider Details

I. General information

NPI: 1508001421
Provider Name (Legal Business Name): MR. JIMMIE LEE DUNN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 17TH ST
OAKLAND CA
94612-4124
US

IV. Provider business mailing address

280 17TH ST
OAKLAND CA
94612-4124
US

V. Phone/Fax

Practice location:
  • Phone: 510-238-7040
  • Fax: 510-261-3584
Mailing address:
  • Phone: 510-238-7040
  • Fax: 510-261-3584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: