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General NPI Number Information
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NPI Number | 1043793714
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Entity Type | Individual
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Provider Name | MATTHEW DUNNUCK
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Gender | Male
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 2700 BAY AREA BLVD
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City | HOUSTON
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State | TX
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Zip | 77058-1002
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Country | US
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Telephone | 281-283-3319
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Fax |
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Provider Business Mailing Address
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Address Line | 99 S ALAMANDO RD
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City | MT PLEASANT
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State | MI
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Zip | 48883
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Country | US
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Telephone | 574-309-8447
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 7276
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License Number State | TX
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