Provider Demographics
NPI:1104833870
Name:GUNNER, RACHEL (LCSW,BCD)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:
Last Name:GUNNER
Suffix:
Gender:F
Credentials:LCSW,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 E RIVERSIDE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-1357
Mailing Address - Country:US
Mailing Address - Phone:512-445-5633
Mailing Address - Fax:
Practice Address - Street 1:512 E. RIVERSIDE DR.
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:SD
Practice Address - Zip Code:78704
Practice Address - Country:US
Practice Address - Phone:512-445-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS57AMedicare ID - Type Unspecified