Provider Demographics
NPI:1265653190
Name:DUNKLEY, GREGORY J (MS)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:J
Last Name:DUNKLEY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12485 W ROCKBURY ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-0015
Mailing Address - Country:US
Mailing Address - Phone:208-921-4129
Mailing Address - Fax:208-658-0153
Practice Address - Street 1:10740 W FAIRVIEW AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-7926
Practice Address - Country:US
Practice Address - Phone:208-376-0190
Practice Address - Fax:208-658-6299
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-3165106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDQ7421OtherBCBS SERVICE #
ID000010156963OtherREGENCE BS IDENT. #