Provider Demographics
NPI:1124195763
Name:BRAME GUNNIN, MICHELLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:BRAME GUNNIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 IMPALA CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2224
Mailing Address - Country:US
Mailing Address - Phone:210-481-1785
Mailing Address - Fax:
Practice Address - Street 1:11122 WURZBACH RD
Practice Address - Street 2:SUITE 302
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2573
Practice Address - Country:US
Practice Address - Phone:210-558-0409
Practice Address - Fax:210-558-0410
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19739101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional