Provider Demographics
NPI:1497931711
Name:DUNN, MYESHA NICOLE (MA)
Entity Type:Individual
Prefix:MISS
First Name:MYESHA
Middle Name:NICOLE
Last Name:DUNN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:MYESHA
Other - Middle Name:NICOLE
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1214 EDDINGTON ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3440
Mailing Address - Country:US
Mailing Address - Phone:909-931-1137
Mailing Address - Fax:909-466-4815
Practice Address - Street 1:1214 EDDINGTON ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3440
Practice Address - Country:US
Practice Address - Phone:909-931-1137
Practice Address - Fax:909-466-4815
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53009106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist