Healthcare Provider Details

I. General information

NPI: 1679661706
Provider Name (Legal Business Name): GAIL BECKER L.L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3865 S MACKINAC TRL
SAULT SAINTE MARIE MI
49783-9286
US

IV. Provider business mailing address

3865 S MACKINAC TRL
SAULT SAINTE MARIE MI
49783-9286
US

V. Phone/Fax

Practice location:
  • Phone: 906-632-2805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberGB008950
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: