Provider Demographics
NPI:1255669909
Name:DUNN, MICHAELLA RUTH (LMHP)
Entity Type:Individual
Prefix:MRS
First Name:MICHAELLA
Middle Name:RUTH
Last Name:DUNN
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 MARCY ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1038
Mailing Address - Country:US
Mailing Address - Phone:402-917-2629
Mailing Address - Fax:712-256-9766
Practice Address - Street 1:300 W BROADWAY STE 270
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9028
Practice Address - Country:US
Practice Address - Phone:402-397-9866
Practice Address - Fax:402-397-1404
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE90161041C0700X
IA0080391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical