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General NPI Number Information
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NPI Number | 1154528651
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Entity Type | Individual
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Provider Name | TERENCE MICHAEL GUNVILLE LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 16655 W BLUEMOUND RD SUITE 300 BRAY CONSULTANTS
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City | BROOKFIELD
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State | WI
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Zip | 53005
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Country | US
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Telephone | 262-821-0588
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Fax | 262-821-0599
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Provider Business Mailing Address
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Address Line | 920 TENNY AVENUE
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City | HARTLANDD
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State | WI
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Zip | 53029
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Country | US
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Telephone | 262-367-5160
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LCSW835123
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License Number State | WI
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