Provider Demographics
NPI:1477278737
Name:GUNTHARP, TESSA KAITLYN
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:KAITLYN
Last Name:GUNTHARP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 FAWN GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MANTACHIE
Mailing Address - State:MS
Mailing Address - Zip Code:38855-7061
Mailing Address - Country:US
Mailing Address - Phone:662-891-0772
Mailing Address - Fax:
Practice Address - Street 1:1215 EARL FRYE BLVD
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5509
Practice Address - Country:US
Practice Address - Phone:662-256-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst