| Doctor Name: | DR. GARY EDWIN GUNDERSON |
| NPI Number: | 1093835159 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ED. D, MS LP |
| License Number: | LP2801 |
| Business Practice Address: | 702 Sw 5th St Brainerd, MN - 564013997 |
| Business Phone Number: | 2184546369 |
| Business Fax Number: | |
| Mailing Address: | 28022 County Road 107, PEQUOT LAKES |
| State: | MN |
| Postal Code: | 564723312 |
| Phone Number: | 2188382448 |
| Fax Number: | |
| NPI Enumeration Date: | 03/30/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | LP2801 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |