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NPI Code Detail

MEDICARE: JOHN A GUNVALSON LPCC

MEDICARE: JOHN A GUNVALSON LPCC
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 Counselor343MN

General Provider Information

NPI Number : 1902378763
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN A GUNVALSON LPCC
Provider Business Mailing Address
First Line : 6385 OLD SHADY OAK RD STE 250
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-7705
Country : US
Telephone Number : 952-653-9500
Fax Number : 763-210-5880
Provider Business Practice Location Address
First Line : 6385 OLD SHADY OAK RD STE 250
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-7705
Country : US
Telephone Number : 952-653-9500
Fax Number : 763-210-5880
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2018
Last Update Date : 12/18/2018

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