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NPI Code Detail

MEDICARE: TABATHA GUNN LPC

MEDICARE:   TABATHA  GUNN  LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor65439TX

General Provider Information

NPI Number : 1215364393
Entity Type Code : Individual
Provider Name (Legal Business Name) : TABATHA GUNN LPC
Provider Business Mailing Address
First Line : 213 SILVERLEAF DR
Second Line :
City : FT WORTH
State : TX
Zip : 76112-1130
Country : US
Telephone Number : 817-688-8143
Fax Number :
Provider Business Practice Location Address
First Line : 213 SILVERLEAF DR
Second Line :
City : FT WORTH
State : TX
Zip : 76112-1130
Country : US
Telephone Number : 817-688-8143
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2013
Last Update Date : 10/03/2013

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Directions to “ TABATHA GUNN LPC” Practice Location

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