Healthcare Provider Details

I. General information

NPI: 1457469603
Provider Name (Legal Business Name): JONATHAN B GAMM L.M.S.W., L.L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 E NEWELL ST
WHITE CLOUD MI
49349-8795
US

IV. Provider business mailing address

1973 S 88TH AVE
SHELBY MI
49455-9779
US

V. Phone/Fax

Practice location:
  • Phone: 231-689-7330
  • Fax: 231-689-7345
Mailing address:
  • Phone: 231-689-7330
  • Fax: 231-689-7345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801018684
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301001330
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: