Healthcare Provider Details

I. General information

NPI: 1053347971
Provider Name (Legal Business Name): WILLIAM B GUNN JR. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT ST CRFHC
CONCORD NH
03301-7539
US

IV. Provider business mailing address

250 PLEASANT ST CRFHC
CONCORD NH
03301-7539
US

V. Phone/Fax

Practice location:
  • Phone: 603-230-7235
  • Fax: 603-228-7307
Mailing address:
  • Phone: 603-230-7235
  • Fax: 603-228-7307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number842
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number38
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: