Provider Demographics
NPI:1659380756
Name:DUNCKLEY, RUSSELL A (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:A
Last Name:DUNCKLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 OAK LAWN AVE
Mailing Address - Street 2:SUITE 275
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4308
Mailing Address - Country:US
Mailing Address - Phone:214-522-0351
Mailing Address - Fax:214-522-0593
Practice Address - Street 1:3500 OAK LAWN AVE
Practice Address - Street 2:SUITE 275
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4308
Practice Address - Country:US
Practice Address - Phone:214-522-0351
Practice Address - Fax:214-522-0593
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21515103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00D66ROtherBC/BS TX
TX75-2365650OtherPHCS
TX75-2365650OtherPHCS