MEDICARE: DEREK JAMES NUNN MA, LPCC7195

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	LPCC7195	CA

General Provider Information

NPI Number	:	1164915302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK JAMES NUNN MA, LPCC7195

Provider Business Mailing Address
First Line	:	5138 W ROBERTS AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-7757
Country	:	US
Telephone Number	:	559-385-1319
Fax Number	:

Provider Business Practice Location Address
First Line	:	2540 W SHAW LN STE 107
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-2700
Country	:	US
Telephone Number	:	559-256-7626
Fax Number	:

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

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	11/12/2019

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