Provider Demographics
NPI:1912007618
Name:GUNTHER, KATHLEEN SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:SUSAN
Last Name:GUNTHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15450 E JEFFERSON AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-2028
Mailing Address - Country:US
Mailing Address - Phone:313-821-1319
Mailing Address - Fax:
Practice Address - Street 1:15450 E JEFFERSON AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-2028
Practice Address - Country:US
Practice Address - Phone:313-821-1319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003078103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical