Basic Information
Provider Information
NPI: 1538505185
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUNN
FirstName: GINGER
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1336 TROPICAL CV
Address2:  
City: GULFPORT
State: MS
PostalCode: 395076003
CountryCode: US
TelephoneNumber: 8165894289
FaxNumber:  
Practice Location
Address1: 400 VETERANS AVE
Address2:  
City: BILOXI
State: MS
PostalCode: 395312410
CountryCode: US
TelephoneNumber: 2285235000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/21/2013
LastUpdateDate: 05/21/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X52915MSY Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


Home