Provider Demographics
NPI:1437245156
Name:GUNDERSON, JAMES A (LICSW,MSW,ACSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:GUNDERSON
Suffix:
Gender:M
Credentials:LICSW,MSW,ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 3777
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383
Mailing Address - Country:US
Mailing Address - Phone:360-698-8823
Mailing Address - Fax:
Practice Address - Street 1:3531 CARLTON ST. NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9838
Practice Address - Country:US
Practice Address - Phone:360-698-8823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00005073101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91128353498383A001OtherTRIWEST