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General NPI Number Information
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NPI Number | 1396950564
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Entity Type | Individual
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Provider Name | RENA MAE GAUNA LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 167 NORTH MAIN STREET
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City | TUBA CITY
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State | AZ
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Zip | 86045-0600
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Country | US
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Telephone | 928-283-2501
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Fax | 928-283-8024
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Provider Business Mailing Address
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Address Line | P. O. BOX P.O. BOX 3237
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City | TUBA CITY
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State | AZ
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Zip | 86045-3237
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Country | US
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Telephone | 928-283-2501
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Fax | 928-283-8024
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW3485
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License Number State | AZ
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