Healthcare Provider Details

I. General information

NPI: 1518374982
Provider Name (Legal Business Name): GINA N DUNCKEL SMITH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GINA DUNCKEL PSY.D.

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MARINA BAY DR BLDG 113E
CLEAR LAKE SHORES TX
77565-2263
US

IV. Provider business mailing address

PO BOX 303
KEMAH TX
77565-0303
US

V. Phone/Fax

Practice location:
  • Phone: 281-910-3913
  • Fax:
Mailing address:
  • Phone: 281-910-3913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number38013
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: