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General NPI Number Information
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NPI Number | 1861692824
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Entity Type | Organization
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Legal Business Name | GAYLE WALLS-BROWN PLLC
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 20700 CIVIC CENTER DR 170
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City | SOUTHFIELD
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State | MI
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Zip | 48076-4140
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Country | US
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Telephone | 313-610-5711
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Fax |
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Provider Business Mailing Address
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Address Line | 19670 CHESTERFIELD RD
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City | DETROIT
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State | MI
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Zip | 48221-1831
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Country | US
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Telephone | 313-610-5711
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | MRS. GAYLE ELAINE WALLS-BROWN
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Credential | LMSW, ACSW
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Telephone | 313-610-5711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801080183
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License Number State | MI
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