Provider Demographics
NPI:1124448956
Name:DUNN, MICHAEL ROSS (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROSS
Last Name:DUNN
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-7329
Mailing Address - Country:US
Mailing Address - Phone:405-837-1033
Mailing Address - Fax:405-300-0646
Practice Address - Street 1:1400 SE 4TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-7329
Practice Address - Country:US
Practice Address - Phone:405-837-1033
Practice Address - Fax:405-300-0646
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-19
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6867101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor