Basic Information
| Provider Information | |||||||||
| NPI: | 1386906972 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNLOP | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.S., PLMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 N. 5TH ST. | ||||||||
| Address2: | P.O. BOX 147 | ||||||||
| City: | O'NEILL | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023364841 | ||||||||
| FaxNumber: | 4023364640 | ||||||||
| Practice Location | |||||||||
| Address1: | 2315 W. 39TH ST. | ||||||||
| Address2: | SUITE 109 | ||||||||
| City: | KEARNEY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3088300612 | ||||||||
| FaxNumber: | 3082370720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2012 | ||||||||
| LastUpdateDate: | 05/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 9673 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 10025001700 | 05 | NE | MEDICAID |