Healthcare Provider Details

I. General information

NPI: 1407941628
Provider Name (Legal Business Name): GARY DUNN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF VETERANS AFFAIRS 1101 VETERANS DRIVE
LEXINGTON KY
40502-2236
US

IV. Provider business mailing address

DEPARTMENT OF VETERANS AFFAIRS 1101 VETERANS DRIVE
LEXINGTON KY
40502-2236
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax:
Mailing address:
  • Phone: 859-233-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0974
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: