Healthcare Provider Details

I. General information

NPI: 1780248989
Provider Name (Legal Business Name): GINA DUNCKEL PSYD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
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: 281-910-3303
  • Fax:
Mailing address:
  • Phone: 281-910-3913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. GINA N DUNCKEL SMITH
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSYD
Phone: 281-910-3313