Provider Demographics
NPI:1730418419
Name:GUNN, ROSS III (MA)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:
Last Name:GUNN
Suffix:III
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 532605
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-9998
Mailing Address - Country:US
Mailing Address - Phone:360-991-7700
Mailing Address - Fax:
Practice Address - Street 1:106 LAUKAHI ST
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7177
Practice Address - Country:US
Practice Address - Phone:360-991-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA020701-RC00041902101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional