Provider Demographics
NPI:1669470266
Name:GVENTER, DAWN (PSY D)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:
Last Name:GVENTER
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 BELLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-6732
Mailing Address - Country:US
Mailing Address - Phone:248-303-1382
Mailing Address - Fax:248-268-0128
Practice Address - Street 1:1179 BELLWOOD CT
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-6732
Practice Address - Country:US
Practice Address - Phone:248-303-1382
Practice Address - Fax:248-268-0128
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013477103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86825AOtherBCBS OF TEXAS
TX162144301Medicaid
TX162144301Medicaid