Healthcare Provider Details

I. General information

NPI: 1972547701
Provider Name (Legal Business Name): BONNIE J GUNN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S 7TH ST
CHICKASHA OK
73018-3301
US

IV. Provider business mailing address

117 S 7TH ST
CHICKASHA OK
73018-3301
US

V. Phone/Fax

Practice location:
  • Phone: 405-222-4786
  • Fax: 405-222-1615
Mailing address:
  • Phone: 405-222-4786
  • Fax: 405-222-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2527
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: