Provider Demographics
NPI:1275913774
Name:DUNBAR, GLEE LENELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:GLEE
Middle Name:LENELLE
Last Name:DUNBAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:MT
Mailing Address - Zip Code:59741-0918
Mailing Address - Country:US
Mailing Address - Phone:252-945-3122
Mailing Address - Fax:
Practice Address - Street 1:108 W MAIN ST UNIT 202
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:MT
Practice Address - Zip Code:59741-2353
Practice Address - Country:US
Practice Address - Phone:252-945-3122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0108381041C0700X
MTBBH-LCSW-LIC-250181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7254286Medicaid