Provider Demographics
NPI:1154579787
Name:DUNN, KELLY MICHELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MICHELLE
Last Name:DUNN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:MICHELLE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:11833 STERLING PANORAMA TER
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5017
Mailing Address - Country:US
Mailing Address - Phone:512-263-5527
Mailing Address - Fax:
Practice Address - Street 1:11833 STERLING PANORAMA TER
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-5017
Practice Address - Country:US
Practice Address - Phone:512-263-5527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX373381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical