Provider Demographics
NPI:1649802141
Name:DUNN, MARISSA LOUISE (RBT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LOUISE
Last Name:DUNN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 PRONGHORN TRL STE A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6082
Mailing Address - Country:US
Mailing Address - Phone:406-624-6669
Mailing Address - Fax:
Practice Address - Street 1:554 PRONGHORN TRL STE A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6082
Practice Address - Country:US
Practice Address - Phone:406-624-6669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician