Provider Demographics
NPI:1164915302
Name:NUNN, DEREK JAMES (MA, LPCC7195)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:JAMES
Last Name:NUNN
Suffix:
Gender:M
Credentials:MA, LPCC7195
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5138 W ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-7757
Mailing Address - Country:US
Mailing Address - Phone:559-385-1319
Mailing Address - Fax:
Practice Address - Street 1:2540 W SHAW LN STE 107
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2700
Practice Address - Country:US
Practice Address - Phone:559-256-7626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC7195101YM0800X
CAPCCI4091101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty