Provider Demographics
NPI:1518374982
Name:SMITH, GINA N DUNCKEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:N DUNCKEL
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:DUNCKEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-0303
Mailing Address - Country:US
Mailing Address - Phone:281-910-3913
Mailing Address - Fax:
Practice Address - Street 1:1500 MARINA BAY DR BLDG 113E
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE SHORES
Practice Address - State:TX
Practice Address - Zip Code:77565-2263
Practice Address - Country:US
Practice Address - Phone:281-910-3913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38013103T00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program