Provider Demographics
NPI:1689416661
Name:GABRIELLE SUNDERLAND, LLC
Entity type:Organization
Organization Name:GABRIELLE SUNDERLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT
Authorized Official - Phone:316-371-5686
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:GARDEN PLAIN
Mailing Address - State:KS
Mailing Address - Zip Code:67050-0246
Mailing Address - Country:US
Mailing Address - Phone:316-371-5686
Mailing Address - Fax:
Practice Address - Street 1:11940 W CENTRAL AVE STE 118
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-5180
Practice Address - Country:US
Practice Address - Phone:316-371-5686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)