MEDICARE: MS. MAKQUEL D. GAILES

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	171M00000X	Case Manager/Care Coordinator
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1609347780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAKQUEL D. GAILES

Provider Business Mailing Address
First Line	:	5511 HIDEAWAY DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-5156
Country	:	US
Telephone Number	:	318-229-3070
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 VERSAILLES BLVD
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2351
Country	:	US
Telephone Number	:	318-449-4474
Fax Number	:

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

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	12/02/2025

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