Provider Demographics
NPI:1528616653
Name:GUNDACKER, MARGUERITE ANN (LPC)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:ANN
Last Name:GUNDACKER
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 1:186 E SHELDON ST # 1141
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-3114
Mailing Address - Country:US
Mailing Address - Phone:928-361-9198
Mailing Address - Fax:928-420-8221
Practice Address - Street 1:2490 SANDIA DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-361-9198
Practice Address - Fax:928-420-8221
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-02
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20747101YP2500X
AZLAC-13181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional