Provider Demographics
NPI:1982754479
Name:GUNDERSON, LOUIE MARTIN
Entity Type:Individual
Prefix:MR
First Name:LOUIE
Middle Name:MARTIN
Last Name:GUNDERSON
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 1:14240 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1940
Mailing Address - Country:US
Mailing Address - Phone:562-946-1587
Mailing Address - Fax:562-946-1587
Practice Address - Street 1:14240 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1940
Practice Address - Country:US
Practice Address - Phone:562-946-1587
Practice Address - Fax:562-946-1587
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)