Provider Demographics
NPI:1871085142
Name:GUNN, JEREMY WINSTON (MA, LPC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:WINSTON
Last Name:GUNN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 MOSSROCK STE 227
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5138
Mailing Address - Country:US
Mailing Address - Phone:210-557-4884
Mailing Address - Fax:210-714-9517
Practice Address - Street 1:2929 MOSSROCK STE 227
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5138
Practice Address - Country:US
Practice Address - Phone:210-557-4884
Practice Address - Fax:210-714-9517
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-03
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32106101YA0400X
TX76012101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)