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General NPI Number Information
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NPI Number | 1558778878
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Entity Type | Individual
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Provider Name | NICOLE GEGAS PH.D
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Gender | Female
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 3005 BOARDWALK ST STE 201
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City | ANN ARBOR
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State | MI
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Zip | 48108-5218
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Country | US
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Telephone | 734-222-9277
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Fax |
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Provider Business Mailing Address
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Address Line | DEPT 781625 PO BOX 78000
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City | COLUMBUS
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State | OH
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Zip | 43271-5194
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Country | US
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Telephone | 614-355-8004
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Fax | 614-355-2220
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6351004729
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301019738
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License Number State | MI
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