Provider Demographics
NPI:1841657962
Name:DUNKLIN HEALTH AND WELLNESS MANAGEMENT, LLC
Entity type:Organization
Organization Name:DUNKLIN HEALTH AND WELLNESS MANAGEMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUNKLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:210-665-8875
Mailing Address - Street 1:PO BOX 90021
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-9021
Mailing Address - Country:US
Mailing Address - Phone:210-665-8875
Mailing Address - Fax:
Practice Address - Street 1:3201 CHERRY RIDGE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4823
Practice Address - Country:US
Practice Address - Phone:210-665-8875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-15-20931103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-15-20931OtherBACB CERTIFICATION