Provider Information for 1033611835
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MARY ANNE GUNTER LAC, LAMFT
Sex: Female
NPI: 1033611835
Last Updated: 2018-09-25
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1033611835 | ||||||||
| Enumeration Date | 2018-03-07 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 110 SKYLINE DR RUSSELLVILLE, AR 72801-3362 United States Phone: 479-967-5570 | Fax: | ||||||||
| Primary Practice Address | 113 NORTH PEABODY SUITE B MOUNTAIN VIEW, AR 72560 United States Phone: 870-269-4193 | Fax: | ||||||||
| Secondary Practice Address(es) | 25 GAP RD | ||||||||
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