Provider Demographics
NPI:1548637655
Name:CUNNUNGHAM, GERALD
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:CUNNUNGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 CROWN DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-2205
Mailing Address - Country:US
Mailing Address - Phone:775-354-3991
Mailing Address - Fax:
Practice Address - Street 1:1285 CROWN DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-2205
Practice Address - Country:US
Practice Address - Phone:775-354-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst