Provider Demographics
NPI:1275298788
Name:DUNGY, DIANA KAYE (LCDC-I,DOEP,BA,CCJPA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:KAYE
Last Name:DUNGY
Suffix:
Gender:F
Credentials:LCDC-I,DOEP,BA,CCJPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COBIA DR APT 1624
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1694
Mailing Address - Country:US
Mailing Address - Phone:832-891-8963
Mailing Address - Fax:
Practice Address - Street 1:1250 TEXAS PKWY STE A1
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-6467
Practice Address - Country:US
Practice Address - Phone:832-891-8963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
TX48836251B00000X, 101YA0400X
TX105673405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251B00000XAgenciesCase Management
No405300000XOther Service ProvidersPrevention Professional