=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386906972
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRY L. DUNLOP M.S., PLMHP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2012
-----------------------------------------------------
Last Update Date | 05/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2315 W. 39TH ST. SUITE 109
-----------------------------------------------------
City | KEARNEY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-830-0612
-----------------------------------------------------
Fax | 308-237-0720
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 N. 5TH ST. P.O. BOX 147
-----------------------------------------------------
City | O'NEILL
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-336-4841
-----------------------------------------------------
Fax | 402-336-4640
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 9673
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------