Healthcare Provider Details

I. General information

NPI: 1154353241
Provider Name (Legal Business Name): JEMECE MICHELLE GASAWAY MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. JEMECE MICHELLE RICHARD

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14800 QUORUM DR STE 255
DALLAS TX
75254-1415
US

IV. Provider business mailing address

14800 QUORUM DR STE 255
DALLAS TX
75254-1415
US

V. Phone/Fax

Practice location:
  • Phone: 214-702-1231
  • Fax:
Mailing address:
  • Phone: 214-702-1231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1020
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number963
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number62542
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number62542
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: