Provider Demographics
NPI:1154528651
Name:GUNVILLE, TERENCE MICHAEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:MICHAEL
Last Name:GUNVILLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 TENNY AVENUE
Mailing Address - Street 2:
Mailing Address - City:HARTLANDD
Mailing Address - State:WI
Mailing Address - Zip Code:53029
Mailing Address - Country:US
Mailing Address - Phone:262-367-5160
Mailing Address - Fax:
Practice Address - Street 1:16655 W BLUEMOUND RD
Practice Address - Street 2:SUITE 300 BRAY CONSULTANTS
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:262-821-0588
Practice Address - Fax:262-821-0599
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WILCSW835123101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor