Healthcare Provider Details

I. General information

NPI: 1174131833
Provider Name (Legal Business Name): JAMES RYAN DUNN LMHC, ATR-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BALSA DR
SANTA FE NM
87508-8317
US

IV. Provider business mailing address

15 BALSA DR
SANTA FE NM
87508-8317
US

V. Phone/Fax

Practice location:
  • Phone: 913-706-9383
  • Fax:
Mailing address:
  • Phone: 913-706-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0211181
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: