Healthcare Provider Details

I. General information

NPI: 1730459793
Provider Name (Legal Business Name): BRYN DUNGAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 E MAIN STREET SUITE 304
PLAINFIELD IN
46168-2831
US

IV. Provider business mailing address

2680 E MAIN STREET SUITE 304
PLAINFIELD IN
46168-2831
US

V. Phone/Fax

Practice location:
  • Phone: 317-384-7196
  • Fax: 317-203-7355
Mailing address:
  • Phone: 317-384-7196
  • Fax: 317-203-7353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042567A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: