Provider Demographics
NPI:1144069352
Name:DUNKIN, RIAN B (LPC, MA)
Entity type:Individual
Prefix:
First Name:RIAN
Middle Name:B
Last Name:DUNKIN
Suffix:
Gender:F
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4429 S RIVER BLVD STE BC
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-4659
Mailing Address - Country:US
Mailing Address - Phone:816-768-0090
Mailing Address - Fax:816-912-1739
Practice Address - Street 1:200 NE MISSOURI RD STE 307
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4722
Practice Address - Country:US
Practice Address - Phone:816-839-9427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016008299261Q00000X
MO2022049227101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center