Provider Demographics
NPI:1952869570
Name:GUNN, TERRANCE LAVELL (PROFESSIONAL COUNSEL)
Entity Type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:LAVELL
Last Name:GUNN
Suffix:
Gender:M
Credentials:PROFESSIONAL COUNSEL
Other - Prefix:
Other - First Name:TERRANCE
Other - Middle Name:LAVELL
Other - Last Name:GUNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PROFESSIONAL COUNSEL
Mailing Address - Street 1:1955 LAWN ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53404-2921
Mailing Address - Country:US
Mailing Address - Phone:262-664-9144
Mailing Address - Fax:
Practice Address - Street 1:151 S 84TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-1456
Practice Address - Country:US
Practice Address - Phone:414-476-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4284226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health