Basic Information
| Provider Information | |||||||||
| NPI: | 1255669909 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUNN | ||||||||
| FirstName: | MICHAELLA | ||||||||
| MiddleName: | RUTH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4328 MARCY ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681051038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029172629 | ||||||||
| FaxNumber: | 7122569766 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 W BROADWAY STE 270 | ||||||||
| Address2: | |||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515039028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023979866 | ||||||||
| FaxNumber: | 4023971404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2009 | ||||||||
| LastUpdateDate: | 01/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 9016 | NE | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 008039 | IA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.