Provider Demographics
NPI:1821869371
Name:DR. ALLISON GUNDERSON LLC
Entity Type:Organization
Organization Name:DR. ALLISON GUNDERSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-388-4724
Mailing Address - Street 1:54-111 IMUA PL
Mailing Address - Street 2:
Mailing Address - City:HAUULA
Mailing Address - State:HI
Mailing Address - Zip Code:96717-9517
Mailing Address - Country:US
Mailing Address - Phone:808-388-4724
Mailing Address - Fax:
Practice Address - Street 1:46-001 KAMEHAMEHA HWY STE 419A
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3749
Practice Address - Country:US
Practice Address - Phone:808-388-4724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)