Provider Demographics
NPI:1205230828
Name:DUNLAP, GARRETT (MED, BSL, LPC, BCBA)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:MED, BSL, LPC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3944 LAUREL OAK CIR
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-9711
Mailing Address - Country:US
Mailing Address - Phone:724-396-9561
Mailing Address - Fax:
Practice Address - Street 1:6315 FORBES AVE
Practice Address - Street 2:SUITE B14
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1745
Practice Address - Country:US
Practice Address - Phone:724-396-9561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007806101YP2500X
PABH000550103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst