MEDICARE: REBECCA GAGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1003381468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA GAGE

Provider Business Mailing Address
First Line	:	4017 W MAIN ST STE 100
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-3731
Country	:	US
Telephone Number	:	269-488-5903
Fax Number	:

Provider Business Practice Location Address
First Line	:	4017 W MAIN ST STE 100
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-3731
Country	:	US
Telephone Number	:	269-775-1283
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2018
Last Update Date	:	10/11/2018

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Directions to “ REBECCA GAGE ” Practice Location

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