Provider Demographics
NPI:1205045176
Name:GUNNELL, MEGAN KATE (MSW, MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:KATE
Last Name:GUNNELL
Suffix:
Gender:F
Credentials:MSW, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 BARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1763
Mailing Address - Country:US
Mailing Address - Phone:248-635-5285
Mailing Address - Fax:
Practice Address - Street 1:504 BARRINGTON RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1763
Practice Address - Country:US
Practice Address - Phone:248-635-5285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17271631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical