Provider Demographics
NPI:1902378763
Name:GUNVALSON, JOHN A (LPCC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:GUNVALSON
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6385 OLD SHADY OAK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7705
Mailing Address - Country:US
Mailing Address - Phone:952-653-9500
Mailing Address - Fax:763-210-5880
Practice Address - Street 1:6385 OLD SHADY OAK RD STE 250
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7705
Practice Address - Country:US
Practice Address - Phone:952-653-9500
Practice Address - Fax:763-210-5880
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health