Provider Demographics
NPI:1356909154
Name:DUNBAR, DESIREE DANIELLE (PSYD)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:DANIELLE
Last Name:DUNBAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:DESIREE
Other - Middle Name:DANIELLE
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:18840 SW BOONES FERRY RD STE 208
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9688
Mailing Address - Country:US
Mailing Address - Phone:503-427-2394
Mailing Address - Fax:503-454-0763
Practice Address - Street 1:18840 SW BOONES FERRY RD STE 208
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9688
Practice Address - Country:US
Practice Address - Phone:503-427-2394
Practice Address - Fax:503-454-0763
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006120103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical