Provider Demographics
NPI:1851423487
Name:HUNNICUTT, ADRIENNE (PSYD)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:HUNNICUTT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 S LANCASTER RD STE 181
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-4541
Mailing Address - Country:US
Mailing Address - Phone:469-488-4600
Mailing Address - Fax:469-488-4601
Practice Address - Street 1:3200 S LANCASTER RD STE 181
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-4541
Practice Address - Country:US
Practice Address - Phone:469-488-4600
Practice Address - Fax:469-488-4601
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX36613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX358822003Medicaid