Provider Demographics
NPI:1578588042
Name:DUNAGAN, DELORES J BRICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:DELORES
Middle Name:J BRICK
Last Name:DUNAGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 CLARED CIR
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-4918
Mailing Address - Country:US
Mailing Address - Phone:515-314-6607
Mailing Address - Fax:
Practice Address - Street 1:1039 CLARED CIR
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-4918
Practice Address - Country:US
Practice Address - Phone:515-314-6607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00021106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0103929Medicaid