MEDICARE: DR. CHLOE FREYA GUNDST PH.D., D.DIV, Chaplain

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
1	101YP1600X	Pastoral	326506375	NV
2	171W00000X	Contractor	826506375	NV
3	174400000X	Specialist	826506375	NV
4	1744R1102X	Research and Development	836506375	NV
5	175F00000X	Naturopath	826506375	NV
6		DEA	W08058302G Schedule V	D.C.

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	326506375	OTHER	NV	DUNS CCR

General Provider Information

NPI Number	:	1356527550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHLOE FREYA GUNDST PH.D., D.DIV, Chaplain

Provider Business Mailing Address
First Line	:	5841 E. Charleston Blvd
Second Line	:	230-212
City	:	LAS VEGAS
State	:	NV
Zip	:	89142
Country	:	US
Telephone Number	:	7024882144
Fax Number	:	7029216271

Provider Business Practice Location Address
First Line	:	5841 E. Charleston Blvd
Second Line	:	230-212
City	:	LAS VEGAS
State	:	NV
Zip	:	89142
Country	:	US
Telephone Number	:	7024882144
Fax Number	:	7029216271

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	07/07/2012

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