Provider Demographics
NPI:1215364393
Name:GUNN, TABATHA (LPC)
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:
Last Name:GUNN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 SILVERLEAF DR
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-1130
Mailing Address - Country:US
Mailing Address - Phone:817-688-8143
Mailing Address - Fax:
Practice Address - Street 1:213 SILVERLEAF DR
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-1130
Practice Address - Country:US
Practice Address - Phone:817-688-8143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65439101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health