Provider Demographics
NPI:1841244068
Name:TUNKLE, JUDITH ELAINE (MED)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ELAINE
Last Name:TUNKLE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WEST RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2325
Mailing Address - Country:US
Mailing Address - Phone:410-880-2504
Mailing Address - Fax:410-825-0310
Practice Address - Street 1:21 WEST RD
Practice Address - Street 2:SUITE 150
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2325
Practice Address - Country:US
Practice Address - Phone:410-880-2504
Practice Address - Fax:410-825-0310
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1529101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor