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General NPI Number Information
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NPI Number | 1932373008
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Entity Type | Individual
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Provider Name | KRISTY L GATES LMSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 2215 FULLER RD
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City | ANN ARBOR
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State | MI
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Zip | 48105-2303
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Country | US
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Telephone | 734-769-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 14330 58TH ST N APT 4203
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City | CLEARWATER
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State | FL
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Zip | 33760-2801
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Country | US
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Telephone | 586-873-7132
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW10119
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801104569
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License Number State | MI
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