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NPI Code Detail

MEDICARE: MRS. GAYLE BEVILL-DADA

MEDICARE: MRS. GAYLE BEVILL-DADA
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
1101YM0800XMental Health Counselor39001423AIN

General Provider Information

NPI Number : 1093811606
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GAYLE BEVILL-DADA
Provider Business Mailing Address
First Line : 125 LEXINGTON AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46807-2429
Country : US
Telephone Number : 260-456-4801
Fax Number :
Provider Business Practice Location Address
First Line : 3514 STELLHORN RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-4631
Country : US
Telephone Number : 260-492-5500
Fax Number : 260-422-1555
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2006
Last Update Date : 07/08/2007

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