MEDICARE: DENISE GAMRAT MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401007946	MI

General Provider Information

NPI Number	:	1710306824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE GAMRAT MA, LPC

Provider Business Mailing Address
First Line	:	715 LAPEER ROAD
Second Line	:
City	:	LAKE ORION
State	:	MI
Zip	:	48362
Country	:	US
Telephone Number	:	248-693-7526
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 N LAPEER RD
Second Line	:
City	:	LAKE ORION
State	:	MI
Zip	:	48362-1530
Country	:	US
Telephone Number	:	248-693-7526
Fax Number	:	248-693-2426

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	04/16/2014

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