MEDICARE: DR. JAN M DUNN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	12149	TX
2	101YP2500X	Professional Counselor	12149	TX
3	106H00000X	Marriage & Family Therapist	4750	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053394650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAN M DUNN PH.D.

Provider Business Mailing Address
First Line	:	8222 DOUGLAS AVE
Second Line	:	#777
City	:	DALLAS
State	:	TX
Zip	:	75225-5923
Country	:	US
Telephone Number	:	214-890-6637
Fax Number	:	214-276-1380

Provider Business Practice Location Address
First Line	:	8222 DOUGLAS AVE
Second Line	:	#777
City	:	DALLAS
State	:	TX
Zip	:	75225-5923
Country	:	US
Telephone Number	:	214-890-6637
Fax Number	:	214-276-1380

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	06/05/2011

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