1609484666 NPI number — MEGAN GUNNELL, LMSW

Table of content: MARSHA DIANNE BAER MS, LPC (NPI 1316082001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609484666 NPI number — MEGAN GUNNELL, LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEGAN GUNNELL, LMSW
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609484666
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
504 BARRINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROSSE POINTE PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48230-1763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-635-5285
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16824 KERCHEVAL PL STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROSSE POINTE PARK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48230-1566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-635-5285
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUNNELL
Authorized Official First Name:
MEGAN
Authorized Official Middle Name:
KATE
Authorized Official Title or Position:
PSYCHOTHERAPIST
Authorized Official Telephone Number:
248-635-5285

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)