MEDICARE: DUNKLIN HEALTH AND WELLNESS MANAGEMENT, LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1386002913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUNKLIN HEALTH AND WELLNESS MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	PO BOX 90021
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-9021
Country	:	US
Telephone Number	:	210-665-8875
Fax Number	:

Provider Business Practice Location Address
First Line	:	7226 BLANCO RD
Second Line	:	206
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4964
Country	:	US
Telephone Number	:	210-665-8875
Fax Number	:

Authorized Official
Title or Position	:	BEHAVIOR ANALYST
Name	:	RAY CHARLES DUNKLIN
Credential	:	M.S., BCBA
Telephone Number	:	210-665-8875

Provider Enumeration Date	:	02/10/2016
Last Update Date	:	02/10/2016

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