Provider Demographics
NPI:1376949818
Name:GUNSETH, SAMANTHA JO (BA, LCSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:GUNSETH
Suffix:
Gender:F
Credentials:BA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LIMITED AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-3746
Mailing Address - Country:US
Mailing Address - Phone:951-675-6012
Mailing Address - Fax:
Practice Address - Street 1:333 LIMITED AVE
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-3746
Practice Address - Country:US
Practice Address - Phone:951-675-6012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1189481041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health