Healthcare Provider Details

I. General information

NPI: 1780890061
Provider Name (Legal Business Name): DONALD ANTHONY GAMACHE MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FREEDOM DR
NAPOLEON OH
43545-9038
US

IV. Provider business mailing address

1523 S CLINTON ST
DEFIANCE OH
43512-3215
US

V. Phone/Fax

Practice location:
  • Phone: 419-599-1660
  • Fax:
Mailing address:
  • Phone: 419-782-4468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM0000015
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: