Provider Demographics
NPI:1750489902
Name:GUNN, MARY JENKINS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JENKINS
Last Name:GUNN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 POND LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1402
Mailing Address - Country:US
Mailing Address - Phone:541-345-2422
Mailing Address - Fax:
Practice Address - Street 1:740 POND LN
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1402
Practice Address - Country:US
Practice Address - Phone:541-345-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2083101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health