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General NPI Number Information
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NPI Number | 1063382703
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Entity Type | Individual
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Provider Name | JESSICA ANN DUNNAVANT X LCDC
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Gender | Female
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Dates
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Enumeration Date | 11/07/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 1510 S VINE AVE
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City | TYLER
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State | TX
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Zip | 75701-2826
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Country | US
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Telephone | 877-848-9810
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Fax |
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Provider Business Mailing Address
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Address Line | 2718 DANVILLE RD
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City | KILGORE
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State | TX
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Zip | 75662-8890
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16788
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License Number State | TX
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