Individual provider Active NPI

Michelle Dunn, PH.D.

  • Clinical Neuropsychologist
  • Clovis, CA
National Provider Identifier
1508224023
Registry record updated Jan 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
32357 Issued in CA
Practice address
200 W Bullard Ave Ste A4
Clovis, CA 93612-0857
Phone
(559) 574-3002
Fax
(559) 701-0332
NPI assigned
Jan 29, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 32357 CA Primary

Addresses

Primary practice location

200 W Bullard Ave Ste A4
Clovis, CA 93612-0857

Mailing address

200 W Bullard Ave Ste A4
Clovis, CA 93612-0857
Phone (559) 574-3002

Other practice location 1

900 Quebec Ave
Corcoran, CA 93212-9715
Phone (559) 992-7100 ext. 4405

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220308000371 CA Practitioner - Clinical Psychologist 8729472733 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
32357CAMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Dunn Psychological Services, Inc. CurrentSince Nov 13, 2021 Accepting new patients
LGTC Group Clinical Neuropsychologist PastSince May 20, 2025 Accepting new patients
WK Medical Group PastSince Aug 7, 2021 Accepting new patients
Los Gatos Therapy Center PastSince Apr 17, 2022 Accepting new patients

Locations

777 Minnewawa Ave
Ste 4
Clovis, CA 93612
Phone (559) 574-3002

200 W Bullard Ave
Ste A4
Clovis, CA 93612
Phone (559) 322-9821

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1508224023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W BULLARD AVE STE A4",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936120857",
            "telephone_number": "559-574-3002",
            "fax_number": "559-701-0332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W BULLARD AVE STE A4",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936120857",
            "telephone_number": "559-574-3002",
            "fax_number": "559-701-0332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 Quebec Ave",
            "address_purpose": "LOCATION",
            "city": "Corcoran",
            "state": "CA",
            "postal_code": "932129715",
            "country_code": "US",
            "telephone_number": "559-992-7100 x4405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUNN",
        "first_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-29",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "32357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, CA

Sources for this page

Verify at the official NPI Registry.