Provider Demographics
NPI:1578274346
Name:UNCHAINED-GILBERT LLC
Entity Type:Organization
Organization Name:UNCHAINED-GILBERT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-619-2868
Mailing Address - Street 1:2312 E ORLEANS DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-0323
Mailing Address - Country:US
Mailing Address - Phone:480-619-2868
Mailing Address - Fax:
Practice Address - Street 1:201 W GUADALUPE RD STE 310
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3319
Practice Address - Country:US
Practice Address - Phone:480-619-2868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty