Provider Demographics
NPI:1831913524
Name:GUNTHER, JARED D DYLAN
Entity type:Individual
Prefix:
First Name:JARED D
Middle Name:DYLAN
Last Name:GUNTHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 EVANDALE WAY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-0449
Mailing Address - Country:US
Mailing Address - Phone:615-427-3378
Mailing Address - Fax:
Practice Address - Street 1:4555 EVANDALE WAY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-0449
Practice Address - Country:US
Practice Address - Phone:615-427-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health