Gordon Jack Gunn, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

121756-3501 Issued in UT

Practice address

2458 S Camino Real
Washington, UT 84780-8292

Phone

(435) 773-1117

NPI assigned

Jun 12, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2017 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209081600000",
    "number": "1982808176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2458 S CAMINO REAL",
            "city": "WASHINGTON",
            "state": "UT",
            "postal_code": "847808292",
            "telephone_number": "435-773-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2458 S CAMINO REAL",
            "city": "WASHINGTON",
            "state": "UT",
            "postal_code": "847808292",
            "telephone_number": "435-773-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNN",
        "first_name": "GORDON",
        "middle_name": "JACK",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2008-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "121756-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deanna Dawn Garrett
• Milyn Gessele, PHARMD
• Robert Lawrence Gibson, DDS
• Kolene Faye Granger, PHD
• Grant Aj Needham PA Corporation
• Brooke Hamblin
• Lane Hansen, DVM, MS
• David Harless, NP-C
• Kent A. Heideman, D.D.S.
• Richard Kent Heideman, DMD

• Mental Health Counselor in Washington, UT
• Providers in Washington, UT by specialty
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.