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General NPI Number Information
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NPI Number | 1023182847
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Entity Type | Individual
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Provider Name | RUSS DUNSTAN LICENSE PSYCHOLOGIST
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 438 PELLIS RD SUITE 101 TIM BRIDGES PHD & ASSOCIATES INC
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City | GREENSBURG
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State | PA
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Zip | 15601
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Country | US
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Telephone | 724-850-7448
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Fax | 724-850-8143
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Provider Business Mailing Address
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Address Line | 406 WOOD DUCK DR
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City | GREENSBURG
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State | PA
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Zip | 15601-3125
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Country | US
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Telephone | 724-552-2471
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS006500L
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License Number State | PA
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