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General NPI Number Information
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NPI Number | 1265653190
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Entity Type | Individual
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Provider Name | GREGORY J DUNKLEY M.S.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10740 W FAIRVIEW AVE SUITE 100
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City | BOISE
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State | ID
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Zip | 83713-7926
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Country | US
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Telephone | 208-376-0190
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Fax | 208-658-6299
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Provider Business Mailing Address
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Address Line | 12485 W ROCKBURY ST
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City | BOISE
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State | ID
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Zip | 83709-0015
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Country | US
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Telephone | 208-921-4129
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Fax | 208-658-0153
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT-3165
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License Number State | ID
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