Provider Demographics
NPI:1356527550
Name:GUNDST, CHLOE F (PHD, DDIV)
Entity type:Individual
Prefix:DR
First Name:CHLOE
Middle Name:F
Last Name:GUNDST
Suffix:
Gender:F
Credentials:PHD, DDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SIERRA VISTA DR
Mailing Address - Street 2:A-30
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-9307
Mailing Address - Country:US
Mailing Address - Phone:702-764-9854
Mailing Address - Fax:
Practice Address - Street 1:920 SIERRA VISTA DR
Practice Address - Street 2:A-30
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-9307
Practice Address - Country:US
Practice Address - Phone:702-764-9854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM826506375171W00000X, 174400000X, 175F00000X
NM8365063751744R1102X
IL326506375101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171W00000XOther Service ProvidersContractor
No174400000XOther Service ProvidersSpecialist
No1744R1102XOther Service ProvidersSpecialistResearch Study
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV326506375OtherDUNS CCR