Provider Demographics
NPI:1285268102
Name:GUNN, SANDRA MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:GUNN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W IRONWOOD DR STE D-121
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-1403
Mailing Address - Country:US
Mailing Address - Phone:208-277-8371
Mailing Address - Fax:
Practice Address - Street 1:2101 N LAKEWOOD DR STE 225
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2473
Practice Address - Country:US
Practice Address - Phone:208-277-8371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-29
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7252106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist