Basic Information
| Provider Information | |||||||||
| NPI: | 1679841571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNHAM | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | SUZANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58967 BUSINESS CENTER DR | ||||||||
| Address2: | SUITE C, D, & E | ||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922847308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609468200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 58967 BUSINESS CENTER DR | ||||||||
| Address2: | SUITE C, D, & E | ||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922847308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609468200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2011 | ||||||||
| LastUpdateDate: | 04/24/2019 | ||||||||
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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 | 106H00000X | IMF 66372 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | LMFT95760 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.