Provider Demographics
NPI:1578274346
Name:UNCHAINED-GILBERT LLC
Entity type:Organization
Organization Name:UNCHAINED-GILBERT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-536-9473
Mailing Address - Street 1:201 W GUADALUPE RD STE 302
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3333
Mailing Address - Country:US
Mailing Address - Phone:480-536-9473
Mailing Address - Fax:480-536-9744
Practice Address - Street 1:201 W GUADALUPE RD STE 302
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3333
Practice Address - Country:US
Practice Address - Phone:480-536-9473
Practice Address - Fax:480-536-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty