Provider Demographics
NPI:1790326379
Name:CHARLENE MCGUNN PHD PLLC
Entity Type:Organization
Organization Name:CHARLENE MCGUNN PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGUNN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-370-8164
Mailing Address - Street 1:PO BOX 70125
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-0003
Mailing Address - Country:US
Mailing Address - Phone:248-370-8164
Mailing Address - Fax:
Practice Address - Street 1:200 DIVERSION ST STE 150
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2207
Practice Address - Country:US
Practice Address - Phone:248-370-8164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty