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General NPI Number Information
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NPI Number | 1417374141
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Entity Type | Organization
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Legal Business Name | GUNTER PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 3205 WELLINGTON WALK SW
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City | ATLANTA
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State | GA
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Zip | 30331-5452
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Country | US
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Telephone | 404-788-1925
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Fax |
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Provider Business Mailing Address
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Address Line | 3205 WELLINGTON WALK SW
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City | ATLANTA
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State | GA
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Zip | 30331-5452
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Country | US
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Telephone | 404-788-1925
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Fax |
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Authorized Official
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Title or Position | OWNER/SOLE MEMBER
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Name | DR. KENSA K. GUNTER
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Credential | PSY.D.
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Telephone | 404-788-1925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TE1100X
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Taxonomy Name | Exercise & Sports Psychologist
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License Number | PSY003145
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY003145
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License Number State | GA
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