Healthcare Provider Details

I. General information

NPI: 1679042964
Provider Name (Legal Business Name): JORDAN MICHAEL DUNN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7515 GREENVILLE AVE STE 1000
DALLAS TX
75231-3852
US

IV. Provider business mailing address

8722 MANHATTAN AVE
PLANO TX
75024-7745
US

V. Phone/Fax

Practice location:
  • Phone: 844-728-4929
  • Fax:
Mailing address:
  • Phone: 318-381-0585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number76609
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: