Healthcare Provider Details

I. General information

NPI: 1609686831
Provider Name (Legal Business Name): AMANDA M GUNN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 CAMINO DE LA REINA STE 802
SAN DIEGO CA
92108-3110
US

IV. Provider business mailing address

591 CAMINO DE LA REINA STE 802
SAN DIEGO CA
92108-3110
US

V. Phone/Fax

Practice location:
  • Phone: 858-519-8002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC18498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: