Provider Demographics
NPI:1699856435
Name:DUNN, BRENDA RUSSELL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:RUSSELL
Last Name:DUNN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 DANIEL MCCALL DR STE 21
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-7191
Mailing Address - Country:US
Mailing Address - Phone:936-633-6245
Mailing Address - Fax:936-634-3384
Practice Address - Street 1:3402 DANIEL MCCALL DR STE 21
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-7191
Practice Address - Country:US
Practice Address - Phone:936-637-3300
Practice Address - Fax:936-634-3384
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX161811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133330409Medicaid
TX071381003Medicaid
TX071381003Medicaid
TX133330409Medicaid