Provider Demographics
NPI:1174721567
Name:GUNNELL, GORDON ALAN (MS, LMFT, LISAC)
Entity type:Individual
Prefix:MR
First Name:GORDON
Middle Name:ALAN
Last Name:GUNNELL
Suffix:
Gender:M
Credentials:MS, LMFT, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7542
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85216-7542
Mailing Address - Country:US
Mailing Address - Phone:480-220-7050
Mailing Address - Fax:
Practice Address - Street 1:15215 S 48TH ST
Practice Address - Street 2:SUITE 116
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-9142
Practice Address - Country:US
Practice Address - Phone:480-220-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC10515101YA0400X
AZLMFT10218106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist