Basic Information
| Provider Information | |||||||||
| NPI: | 1437239175 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VUNESKY | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 807 S PINHOOK DR | ||||||||
| Address2: | |||||||||
| City: | NIXA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657148030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4177241366 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2200 E SUNSHINE ST | ||||||||
| Address2: | SUITE 312 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658041819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178813759 | ||||||||
| FaxNumber: | 4178817004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 04/01/2008 | ||||||||
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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 | 103TC0700X | 2006029922 | MO | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | R88F227 | 01 | MO | DOMHA MCR MISS PTAN | OTHER |