Provider Demographics
NPI:1194980086
Name:GUNTER, JERROD
Entity type:Individual
Prefix:
First Name:JERROD
Middle Name:
Last Name:GUNTER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JERROD
Other - Middle Name:
Other - Last Name:GUNTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS
Mailing Address - Street 1:5515 SHELBY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7316
Mailing Address - Country:US
Mailing Address - Phone:901-252-7600
Mailing Address - Fax:901-252-7620
Practice Address - Street 1:5515 SHELBY OAKS DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7316
Practice Address - Country:US
Practice Address - Phone:901-252-7600
Practice Address - Fax:901-252-7620
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health