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NPI 1124448956

NPI 1124448956 : MICHAEL ROSS DUNN M.S., LPC. : MOORE, OK

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General NPI Number Information
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    NPI Number           |    1124448956
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    Entity Type          |    Individual 
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    Provider Name        |    MICHAEL ROSS DUNN M.S., LPC.
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    04/19/2014
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    Last Update Date     |    10/31/2018
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Provider Practice Location Address
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    Address Line         |    1400 SE 4TH ST 
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    City                 |    MOORE
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    State                |    OK
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    Zip                  |    73160-7329
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    Country              |    US
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    Telephone            |    405-837-1033
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    Fax                  |    405-300-0646
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Provider Business Mailing Address
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    Address Line         |    1400 SE 4TH ST 
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    City                 |    MOORE
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    State                |    OK
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    Zip                  |    73160-7329
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    Country              |    US
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    Telephone            |    405-837-1033
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    Fax                  |    405-300-0646
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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        |    101Y00000X
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    Taxonomy Name        |    Counselor
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    License Number       |    6867
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    License Number State |    OK
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